Experiences of Adult Patients in Discharge and Recovery from Day Surgery: A Qualitative Systematic Review

Abstract

Review question: The purpose of this systematic review was to critically appraise and synthesise the best available qualitative evidence on the experiences of adult patients in discharge and recovery from day surgery. Introduction: In many countries, day surgery is increasingly considered a default option for surgery. With the increasing popularity of this approach, which enables patients to go home on the same day, it is important to explore and understand how they recover at home. High quality day surgery care requires healthcare professionals, specifically nurses, to be knowledgeable not only in intraoperative procedures but also postoperative care. The quality of patient recovery is considered one of the primary endpoints of day surgery. Postoperative recovery is related to the patient’s ability to return to their usual activities following discharge at home and includes aspects of physical, social and psychological health. It is influenced by many factors including the type of surgery and anaesthesia, patient characteristics and social factors. Moreover, an unrealistic expectation, unmet needs, poor preparation, lack of professional support and insufficient information, which are commonly experienced by day surgery patients, are a major cause of poor recovery. It is therefore important that a systematic review of patient experiences of discharge and recovery following day surgery be undertaken in order to determine their needs and support requirements. Inclusion criteria: Types of participants: This review considered studies that included adult patients 18 years and over who have been discharged from day surgery. This review included any type of day surgery procedure, including ear, nose and throat, general, gynaecological, ophthalmic, oral and maxillofacial, orthopaedic, plastic, urology and vascular surgeries, and breast surgery. Phenomena of interest: This review considered studies that explored adult patients’ experiences of discharge and recovery following day surgery. These experiences included those related to the discharge process and preparation, physical and/or psychosocial recovery (e.g. symptoms such as pain, nausea and fatigue), psychological reactions (e.g. anxiety), complications and their ability to manage and return to normal activities, support requirements from healthcare professionals and/or caregivers/family, and their met and unmet needs. Context: This review included studies on day surgery settings.: Types of studies: This review considered qualitative studies including designs such as phenomenology, grounded theory, ethnography and action research. Descriptive qualitative studies that described the experience or the effects of the experience were also considered. Methods: A systematic review of qualitative studies was undertaken. Published and unpublished studies that met the inclusion criteria were considered. All relevant studies were then critically appraised using the JBI critical appraisal tool; studies were included regardless of their methodological quality. Data were extracted from the included studies using the standardised data extraction tool from JBI. Meta-aggregation was used to synthesise the findings from individual articles. Results: Eleven studies met the inclusion criteria, involving a total of 365 patients. From these studies, 54 unequivocal and eight credible findings with illustrations were extracted. These findings were organised into nine categories, which were then grouped into three synthesised findings: 1) Patients experience day surgery in different ways, with some feeling positive about same-day discharge, others are overwhelmed with discharge information, and some feeling rushed and unprepared to leave the health facility; 2) Day surgery is associated with various physical and emotional symptoms that can cause stress for patients and their caregivers; and 3) Patients require practical self-management strategies and coping skills as well as support from health practitioners, community services and caregivers to facilitate recovery. Conclusions: The findings of this systematic review suggest that day surgery patients and their caregivers generally feel unprepared for discharge, which indicates the need for high-quality education for both patients and caregivers. Self-management strategies and support from caregivers, health professionals and community services are key to postoperative recovery. Future research should focus on identifying effective strategies for training nurses so they can provide such education to patients/caregivers. Additionally, innovative approaches that use technology to provide support for this patient population should be explored and evaluated.