Short summary

This project is based on the challenges experienced in day surgery with suboptimal pain management postoperatively in laparoscopic cholecystectomerized patients after discharge. The project wants to investigate whether using a shared decision tool that containing (a) the current pain schedule, (b) a user-controlled pain schedule, and (c) deselection of a pain schedule, so that the patient and any relatives experience a higher degree of abilities to handle in the post-discharge period. 

Rationale

This is a quality development project that takes into account the challenges experienced in day surgery with suboptimal pain management postoperatively in laparoscopic cholecystectomized This is a quality development project that takes into account the challenges experienced in day surgery with suboptimal pain management postoperatively in laparoscopic cholecystectomized patients after discharge.

Postoperative pain in cholecystectomized patients undergoing day surgery

In 2018, 194 patients were laparoscopic cholecystectomized at the Day Surgical Center in Nyborg, which is one of the highest proportions for this category of patients in a day surgical unit in Denmark.

Cholecystectomized patients are often pain-affected, nauseated and commonly affected in the post-operative course after discharge. In several studies, pain is the overriding problem for the first 3 days following a discharge from a Day Surgical Unit (Jensen et al. 2007; Kavanagh et al. 2008).

It is of great importance that patients receive good pain management also after discharge, as pain will otherwise affect the quality of sleep, mobilization ability and appetite, and thus will result in poorer recurrence (Mitchell 2013).

In a prospective observational study from the Regional Hospital of Horsens in 2017, in which 140 laparoscopic cholecystectomerized patients were included, 59 patients corresponding to 42% had an unplanned contact with the primary sector solely due to postoperative pain. This was the highest diagnosis-related percentage among the 905 included day surgery patients in this study (Brix 2017). Specifically, it is emphasized that there is a lack of knowledge about the experiences of laparoscopic cholecystectomerized patients and the treatment of their postoperative pain when discharged from a day surgery (Brix 2017).

Thus, the nurses often find it difficult for patients and their relatives to be introduced to the postoperative pain management immediately prior to their discharge, as patients are affected by anesthesia and opioids. In addition, some patients are afflicted with nausea to varying degrees at this point.

An English study finds that good treatment and care is provided at the Day Surgical Unit, but the guidance of patients in relation to discharge is deficient. They recommend that patients are already prepared for discharge at the preliminary examination, so that their coping skills are aligned with their needs after discharge (Mottram 2011).

Patient involvement

In order to strengthen patient involvement in the Danish health care system, common decision-making tools have been used to varying degrees in the mid-1990s in relation to choice and opt-out of treatment options. The use of "shared decision" is able to involve patients and relatives, so that knowledge, action skills and responsibilities connect with the patient, the relatives and the health (Majholm et al. 2012).

A shared decision tool provides written evidence-based information on options, benefits, drawbacks and uncertainties, as well as counseling and support for the patient to select the option that best matches his / her preferences (Coulter et al 2011).

The purpose of the study is to optimize the postoperative pain management of the laparoscopic cholecystectomized day surgical patient using a shared decision tool, containing (a) the current pain schedule, (b) a user-controlled pain schedule, and (c) deselection of a pain schedule, so that the patient and any relatives experience a higher degree of abilities to handle in the post-discharge period. 

Description of the cohort

The project includes all patients who have undergone a laparoscopic cholecystectomy at the Day Surgical Center in Nyborg based on the inclusion and exclusion criteria below.

Inclusion criteria:

• Adult patients (older than 17 years)

• ASA group 1-2

• Patients receiving TAP block per or post operatively are included in the study as this usually has a duration of action of less than 12 hours. It is recorded in the data collected whether the patient received TAP block per- or post-operatively.

Exclusion criteria:

• Patients who are transferred postoperatively to another hospital from the Day Surgical Center Nyborg

• Patients who cannot read and understand Danish

• Patients with psychiatric diagnoses

• Patients with Chronic pain

Data and biological material

Data collection via an electronic questionnaire on demographic data and issues regarding pain (pain score) and nausea and treatment, as well as questions to uncover patients' knowledge, responsibility and handling skills in relation to post-operative pain management.

On the 1st, 3rd, and 7th postoperative day, the patient will receive an email with a link to the questionnaire.

Collaborating researchers and departments

Department of Anesthesiology and Intensive Care Medicin, Odense University Hospital 

• Physician, Hanne Tanghus Olsen, PhD

Publications associated with the project

One to two publications is planed