Patient and caregiver experience following ambulatory surgery: qualitative analysis in a cohort of patients 65 yr and older

Purpose: Patients over the age of 65 represent 15% of Canada’s population and one-third of patients undergoing surgery. Older surgical patients often have lasting disability following “minor” ambulatory procedures. This study sought to explore the postoperative experience of ambulatory surgery, as described by older surgical patients and their caregivers.

Methods: Following research ethics board approval, patients 65 yr of age and older who were booked for ambulatory surgical procedures and their caregivers were recruited for the study. Both patients and caregivers were given a daily diary in which to respond to questions assessing functional autonomy, postoperative pain, and caregiver burden. Each daily entry concluded with the following request: “Using the space provided, please record any comments related to your postoperative experience as a patient (caregiver) that you feel are important for us to know.” Responses were analyzed for emergent themes using qualitative description.

The trial on which this analysis was based was registered with Clinical Trials.gov (NCT01382251).

Results: There were 105 patient-caregiver dyads assessed: 90 patients and 64 caregivers offered at least one response. Ten themes, each with a positive and negative construct, clustered around three categories emerged from the comments. Anticipated themes regarding efficacy and side effects of perioperative care were noted. The impact of physical disability on home life was vividly described. Both patients and caregivers expressed concerns regarding preoperative information and postoperative support from the institution.

Conclusions: Patients and caregivers ardently described real challenges during convalescence. Ambulatory care facilities should prepare this specific demographic of patients and caregivers for the post-discharge experience. Paramount for participants was the need for clear communication and a commitment to ongoing support following discharge.