Association between patient activation and delayed discharge in elective laparoscopic cholecystectomy: A prospective cohort analysis

被引：4

作者：

Provenzano, Maria ^{[1
,2
,9
]}

Cillara, Nicola ^{[1
]}

Podda, Mauro ^{[3
]}

Cicalo, Enrico ^{[4
]}

Sotgiu, Giovanni ^{[5
]}

Fransvea, Pietro ^{[6
]}

Poillucci, Gaetano ^{[7
]}

Sechi, Raffaele ^{[1
]}

Deserra, Antonello ^{[1
]}

Jimenez-Herrera, Maria ^{[8
]}

机构：

[1] Santissima Trin Hosp, Dept Surg, Cagliari, Italy

[2] Univ Rovira i Virgili, Tarragona, Spain

[3] Univ Cagliari, Dept Surg Sci, Cagliari, Italy

[4] Univ Sassari, Dept Architecture Design & Urban Planning, Sassari, Italy

[5] Univ Sassari, Dept Med Surg & Expt Sci, Sassari, Italy

[6] Fdn Policlin Univ A Gemelli IRCCS, Emergency Surg & Trauma, Rome, Italy

[7] Osped San Matteo Infermi, Spoleto, Italy

[8] Univ Rovira i Virgili, Nursing Dept, Tarragona 43002, Spain

[9] PO Santissima Trinita, Dept Surg, Via Is Mirrionis 92, I-09121 Cagliari, CA, Italy

来源：

INTERNATIONAL JOURNAL OF NURSING STUDIES | 2024年 / 154卷

关键词：

Patient activation; Delayed discharge; Patient engagement; Laparoscopic cholecystectomy; Surgical outcomes; Unplanned healthcare utilization; SELF-MANAGEMENT; HEALTH OUTCOMES; RISK-FACTORS; CARE; EMPOWERMENT;

D O I：

10.1016/j.ijnurstu.2024.104751

中图分类号：

R47 [护理学];

学科分类号：

1011 ;

摘要：

Background: Improving patient activation may be an effective way to reduce healthcare costs and improve patient outcomes after surgery. Objective: To determine whether preoperative patient activation is associated with delayed discharge (i.e., length of stay >24 h) after elective laparoscopic cholecystectomy. Postoperative symptoms, unscheduled access to healthcare facilities within seven days of surgery, unplanned hospital readmissions, and postoperative complications were analyzed as secondary outcomes. Design: This cohort study was a secondary analysis of the DeDiLaCo study (Delayed Discharge after day-surgery Laparoscopic Cholecystectomy) collecting data of patients undergoing elective laparoscopic cholecystectomy during 2021 in Italy. Data was analyzed from June 2022 to April 2023. Setting: 90 Italian surgical centers participating in the study. Participants: 4708 adult patients with an instrumental diagnosis of gallbladder disease and undergoing laparoscopic cholecystectomy. Patient activation was assessed using the Italian translation of Patient Activation Measure in the preoperative setting. Results: Of 4532 cases analyzed the median (IQR) Patient Activation Measure score was 80.3 (71.2-92.3). Participants were on average 55.5 years of age and 58.1 % were female. Two groups based on the activation level were created: 270 (6 %) had low activation, and 4262 had high activation. The low activation level was associated with the likelihood of delayed discharge (odds ratio [OR] 1.47, 95 % CI, 1.11-1.95; P = .008), higher symptom burden (OR 1.99, 95 % CI 1.49-2.66, P < .0001), and unplanned healthcare utilization within seven days after hospital discharge (OR 1.85, 95 % CI, 1.29-2.63; P = .001). There was no difference between the high and low activation groups in the incidence of postoperative complications (OR 1.28, 95 % CI, 0.95-1.73; P = .10) and hospital readmission after discharge (OR 0.95, 95 % CI, 0.30-3.05; P = .93). Conclusions: Our results suggest that patients with low activation have 1.47 times the risk of delayed discharge compared with patients with higher activation, almost twice the risk of the onset of postoperative symptoms, and 1.85 times the risk of unscheduled use of hospital services. Screening for patient activation in the preoperative setting could not only identify patients not suitable for early discharge, but more importantly, help physicians and nurses develop tailored interventions.

引用

页数：8

共 42 条

[41] Patient reporting of complications after surgery: what impact does documenting postoperative problems from the perspective of the patient using telephone interview and postal questionnaires have on the identification of complications after surgery? [J].