Postoperative Symptom Distress of Orthopaedic Ambulatory Surgery Patients: A Qualitative Study

Purposes: 1) To identify symptoms that cause postoperative distress after orthopedic ambulatory surgery; 2) To identify symptom management techniques that effectively reduce the distress of orthopaedic postoperative symptoms at home after ambulatory surgery; and 3) To identify facilitators and barriers to self-management of postoperative symptoms. Background: Approximately 60% of all surgeries in the U.S. are performed in the ambulatory setting, involving over 34 million patients in 53 million procedures annually. Over 50% of ambulatory surgery patients report moderate to severe postoperative pain and up to 60% of these patients experience post discharge nausea and/or vomiting (PDNV). Other symptoms reported include sore throat, hoarseness, urinary retention, constipation, fatigue, and headache. Patients who have undergone orthopaedic procedures can experience severe nausea and pain at home after discharge. Because these and other symptoms occur at home, many are underreported by patients and caregivers and affect the quality of patient recovery. Postoperative symptom distress prevents timely resumption of activity resulting in prolonged recovery, resource use, and costly delay in resumption of work related activities. Methods: This qualitative study will use two focus groups of ambulatory surgery patients who have experienced a shoulder or knee orthopaedic procedure and their caregivers (N = 12 each group) and two focus groups of multidisciplinary clinicians (N = 12 each group) to elicit understanding of postoperative symptoms and symptom management techniques that effectively reduce the distress of postoperative symptoms. Patients and caregivers will be recruited from the offices of the University of Kentucky Department of Orthopaedic Surgery and Sports Medicine. The purposive sample for the clinician groups will be composed of clinical nurse specialists (N = 2), staff nurses from an ambulatory surgery center (N = 3), athletic trainers or physical therapists (N = 2), an orthopaedic surgeon or fellow (N = 1), pharmacists (N = 1), clinical manager (N = 1) and anesthesia providers (N = 2). The use of four focus groups will encourage rich discussion and facilitate saturation of the data. Participants’ responses to the interview questions and the group discussions will be the focus of our analysis rather than numerical summaries. Consistent with established qualitative analysis procedures, data collection, coding, and analysis will be ongoing and integrated Nursing Relevance: The proposed study will have a substantial impact on postoperative care because it will provide information that will allow development of a tailored mHealth intervention for self-care management of postoperative symptoms at home.