title: Burden incurred by patients and their caregivers after outpatient surgery: a prospective observational study.
abstract: BACKGROUND
  The burden of patients and their caregivers after outpatient surgery has not been fully examined. The number of outpatient surgeries has dramatically increased in the last several years, particularly in the orthopaedic sector. Patients undergoing outpatient orthopaedic procedures may be expected to have more postdischarge pain than those undergoing nonorthopaedic outpatient procedures. In light of this, assessment of patient and caregiver expectations and actual burden after discharge is of importance.
  
  
  OBJECTIVE
  We assessed the impact of outpatient surgery on recovery of patients and their caregivers in the postoperative period by determining (1) expected versus actual time to resume daily activities, including work; (2) expected versus actual recovery at 7 and 30 days postoperatively; and (3) the number of caregivers that felt emotional or physical disturbances from caring for outpatients.
  
  
  METHODS
  Forty-four adult patients undergoing outpatient surgical procedures and their primary caregivers were enrolled in this prospective survey study, of which 30% were orthopaedic patients. Surveys assessing postoperative recovery were given to patients at six time points, on Postoperative Days 0 to 3, 7, and 30. Surveys assessing the burden of informal caregiving were given to each patient's primary caregiver at four time points, on Postoperative Days 1 to 3 and 7. The enrollment rate was 79% (44 enrolled of 56 approached) and the survey response rate was 100% for patients and 93% (41 of 44) for caregivers.
  
  
  RESULTS
  We found that 16 of 44 patients (36%) needed more time than originally anticipated to resume their daily activities and three of 29 patients (10%) needed more time off from work than originally anticipated. Patients were approximately 66% and 88% fully recovered 7 and 30 days after surgery, respectively. The primary caregivers noted disturbances in emotional (nine of 43, 21%) and physical (17 of 43, 40%) aspects of their daily lives while providing care for patients. Our surveyed patients were from multiple surgical services; however, our results may be generalized to an orthopaedic population, although they may underestimate actual results for this population given their generally higher pain scores.
  
  
  CONCLUSIONS
  Patients may take longer to recover from outpatient surgery than previously recognized. As increased pain and prolonged recovery may be associated with increased caregiver burden, these data are of particular significance to the outpatient orthopaedic surgical population. Informal caregiving after outpatient surgery may be an unrecognized physical and psychologic burden and may have a significant societal impact.
  
  
  METHODS
  Level II, prognostic study. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University and School of Medicine, Zayed 8-120, 1800 Orleans Street, Baltimore, MD, 21287, USA.
authors.forename: Asha
authors.initials: A
authors.lastname: Manohar
authors.forename: Kristin
authors.initials: K
authors.lastname: Cheung
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Wu
authors.forename: Tracey S
authors.initials: TS
authors.lastname: Stierer
mesh_terms: D000041:Absenteeism; D000203:Activities of Daily Living; D000223:Adaptation, Psychological; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects*; D017028:Caregivers / Q000523:psychology; D017281:Cost of Illness; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D011446:Prospective Studies; D020127:Recovery of Function; D062707:Return to Work; D018582:Sick Leave; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome