Aanesthetic Agents for Day Surgery - NIHR Health Technology ...

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Appendix 6
TABLE 68 contd Summary of adult patient-based outcomes studies
Study Investigations Outcome Results Conclusions and Reviewers’ comments
and subjects measures grade of evidence
Ratcliff et al, Incidence of Duration of Incidence of emetic Changes in anaesthetic Audit
1994, 192 UK PONV, pain anaesthesia symptoms: 4.2% had practice would seem
levels, overnight PONV at more than one to make day-case No significant differences
Audit admission, Time to eye assessment while in the laparoscopy a more between groups after
patient satis- opening; time day unit. No significant acceptable procedure discharge
faction with to discharge differences between than previously
day surgery groups for nausea, reported Nausea, nausea and
(laparoscopy Postal vomiting or administration vomiting and pain scores
or sterilisation) questionnaire of antiemetics. Morbidity: were lower than reported
(72 patients) 70% of patients were still in other studies
not feeling normal after
Self-assessment 2 days. 7.7% would prefer
pain-intensity to stay overnight
scale
Rhodes, Determine Surgical Mean pain scores for Day-care cataract Grade IV
1991, 193 UK current outcome and insertion of local extraction is acceptable
anaesthetic frequency of anaesthetic blocks: no to patients. Morbidity Survey design
Audit practice for follow-up; significant difference in 47%: minor and selfcataract
day questionnaire; between day patients treated. No significant Authors give a summary
patients; assess VAS pain score or inpatient groups; difference from the of the questionnaire used.
extent of mor- during insertion 47% patients reported inpatient group in Day-care cataract
bidity experi- of local intraoperative discomfort either anaesthetic or extraction was acceptable
enced by anaesthetic on operating table. surgical complications. to patients. Half of patients
patients at home block and Overnight complications: No clear advantage experienced complications
intraoperatively 47% day patients; 37.5% between local at home overnight
inpatients. No significant anaesthesia alone or
difference between groups additional sedation
was demonstrated
Rudkin et al., Review of the Preoperative Longer patient waiting Impact of different day- Pilot study only: reviewed
1996, 194
influence of waiting time; time in hospital-integrated surgery facility types 3 types of day facility;
Australia differently time in recovery facilities using inpatient on efficiency in day- shown to have differing
organised room; compli- mixed recovery room surgery care delivered effects on management
Pilot study: facilities on cations; follow-up care (144.9 min; median efficiencies and patient
prospective patient outcome; information on 125); dedicated day 5% patients reported satisfaction
study common trends patient satis- recovery 102.8 min that information given
and differences faction (median 95); free-standing about anaesthesia was
in eight 72.5 min (median 60.5) poor; 99% patients
Australian day- reported that they had
surgery facilities received good or
satisfactory information
Tong et al., Hypothesised Postanaesthesia 5228 patients studied. Dissatisfaction with Grade IV
1997, 196 Canada that satisfaction discharge Telephone interviews with anaesthesia is a
with anaesthesia scoring system 52%. Global dissatisfaction: predictor of global Survey
Prospective was a predictor 2.5% would decline to dissatisfaction with
survey of global satis- Preoperative return to the same unit; ambulatory surgery. The predictors from this
faction with data presence of postoperative An increased number study need to be validated
ambulatory symptoms, increased of symptoms 24 h after by a second data set from
surgery and dissatisfaction.Variables operation is a predictor another centre. However,
that 24 h post- associated with global of dissatisfaction with the validity of the questions
operative dissatisfaction (68/2730): anaesthesia.The rate, was established in a
symptoms were 18 had personal pref- however, is low previous study
a predictor of erence for inpatient care;
satisfaction with 3 had adverse outcomes; The rate of global
anaesthesia 6 had postoperative dissatisfaction and
symptoms dissatisfaction with
anaesthesia was found
to be low
continued