Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study

Reference: British Journal of Anaesthesia, 117 (6): 758–66 (2016)

Presented by:  Dr Hoon Ying Lau, University College London Hospitals

 

 

 

Expanded abstract

Background

Understanding the patient perspective on healthcare is central to the evaluation of quality. This study measured selected patient-reported outcomes after anaesthesia to identify targets for research and quality improvement.

 

Design

Cross-sectional observational study

Setting

All UK NHS hospitals, 13-14 May 2014

Subjects

Adults undergoing non-obstetric surgery requiring anaesthesia care over a 48 h period

 

Intervention

Within 24 h of surgery, patients completed the Bauer questionnaire (measuring postoperative discomfort and satisfaction with anaesthesia care), and a modified Brice questionnaire to elicit symptoms suggestive of accidental awareness during general anaesthesia (AAGA). Patient, procedural and pharmacological data were recorded to enable exploration of risk factors for these poor outcomes.

 

Outcomes

Patient-reported outcomes (discomfort/satisfaction post op)

Accidental awareness during general anaesthesia (AAGA)

Results

257 hospitals in 171 NHS Trusts participated (97% of eligible organisations).

Baseline characteristics were collected on 16,222 patients; 15,040 (93%) completed postoperative questionnaires.

Anxiety: most frequently cited as the worst perioperative experience.

35% of patients reported severe discomfort in at least one domain: thirst, surgical pain and drowsiness but only 5% reported dissatisfaction with any aspect of anaesthesia-related care

Regional anaesthesia was associated with a reduced burden of side-effects. The incidence of reported AAGA was one in 800 general anaesthetics (0.12%)

 

Conclusions

Anxiety and discomfort after surgery are common; despite this, satisfaction with anaesthesia care in the UK is

high. The inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care

 

 

Strengths

1.    Large scale study with wide distribution (97% of eligible NHS hospitals)

2.    High patient response rate

3.    High level of professional engagement to support delivery at local level

 

Weaknesses

1.    Snapshot study: PROM 24 hours after surgery

2.    Missing out data on urgent/immediate surgical patients (recruitment bias)

3.    Dataset did not include ethnicity: variation in patient satisfaction and expectations

 

Implications

Inconsistent relationship between patient-reported outcome, patient experience and patient satisfaction supports using all three of these domains to provide a comprehensive assessment of the quality of anaesthesia care.

Striking disconnect between high levels of patient satisfaction and the substantial burden of perioperative symptoms.

 

 

Potential for impact

Anxiety and pain were both common and had impact on patient experience, and provide important targets for research and quality improvement.

 

AAGA was uncommon and when it did occur, in only one of 15 patients was it associated with short-term distress or dissatisfaction.