SurgicalPerformance users can capture their Patient-reported Outcomes (PROMS), which complements clinically important outcomes.
PROMS are important because they represent the patient-perspective of a healthcare episode. For example, a patient could have had an uneventful recovery from surgery but continue to be troubled by ongoing pain or fatigue.
We can also use PROMS data to inform patients about what to expect from surgery.
Previously, we discussed how to interpret individual PROMS results. In brief, PROMS collects quality of life outcomes from patients at 2 weeks, 6 weeks and 6 months and computes the obtained values into a score that is compared to the average USA adult population.
Receiving feedback on PROMS after surgery gives surgeons like me great comfort and reassurance. In conversations my patients say that they feel looked after better because they feel that our practice listens and we appear – and indeed we are – interested how they are doing after surgery.
Today, I want to share with you PROMS results of a large cohort of patients. This cohort is comprised of more than 900 women who completed a PROMS survey following major gynaecological surgery (hysterectomy, adnexal surgery, pelvic floor repair, endometriosis surgery).
And these are the results:
- FATIGUE affects the majority of women after gynaecological surgery. Interestingly, more than 40% of women still reporting fatigue 6 months after surgery. Causes for fatigue are largely unknown and specific treatments are not available.
- PAIN INTENSITY seems to be well controlled for the majority of patients. Only 22% of patients complain about significant pain in the early postoperative phase but 8% of women are still affected long-term.
- PAIN INTERFERENCE is an issue for more than 80% of women in the early postoperative recovery and that means that pain prohibits patients from physical, emotional, cognitive or recreational activities. And for 17% of women pain interference is still an issue at 6 months after surgery.
- PHYSICAL FUNCTION refers to a patient’s ability to perform activities of daily living (getting dressed, climbing stairs, getting out of a chair). Our data show that physical function is expectedly low in the early postoperative phase and improves over time. Elderly patients may not recover in physical functioning as per what is “normal” on a population level.
Overall, this is one of the first quantitative research papers on PROMS post-surgery in gynaecology. Expectedly, the majority of patients recover well.
Nevertheless, there seem to be groups of patients who report issues with fatigue or their ability to perform normal daily activities 6 months after surgical treatment. This is very relevant to us because – unless required for medical reasons – we normally don’t see patients after such a long time as the healthcare episodes are normally concluded after 6 weeks.
Possible causes for poor PROMS
Some patients could have PROMS impairment even before surgery; and these impairments may be completely independent of the surgical procedure. Would you be supportive of a PROMS survey that you give to your patients prior to surgery?
We also have to accept that only a third of patients that complete a PROMS survey at 2 weeks, also complete a survey at 6 months. This means that patients who do worse than average may be overrepresented.
In other patients, complications may have caused long-term effects and that is something that at SurgicalPerformance we can continue to watch and report.
However, as an active surgeon, I did notice that some patients complained to me postoperatively – after a “minor procedure” – that they did absolutely not expect to be so much fatigued postoperatively.
Further research – using SurgicalPerformance data – will focus on factors contributing to low PROMS. Those factors could include patient’s age or comorbidities, blood loss, complications, the type of procedure, and others.
These data presented represent the first, initial data and I expect that more users and more surgeons will utilise PROMS in their daily practice to obtain their patients’ view on how their procedure went. This will allow us in the future to conduct further and deeper research.
Data useful for patient information
The other use of this small study is that SurgicalPerformance users are now in a much better position to answer their patients’ question “How long does it take to recover from surgery?” This data will inform all our patients’ conversations:
- Patient data show that we normally manage your pain levels well.
- However, even after 6 weeks pain levels may interfere with your ability to perform normal activities (e.g., going on vacation).
- Whereas after 6 weeks, more than 60% of patients will be able to perform activities of daily living.
- Initially there is a high risk of fatigue but that will drop to 50% after 6 weeks and 40% after 6 months.
As gynaecological surgeons we should inform patients and this data can help with that. We also need to help patients set expectations especially when poor preoperative quality of life may not return to normal and healthy levels postoperatively.
SurgicalPerformance helps our surgeons to know better_
PROMS will not only provide valuable information about the patient’s perspective but will also strengthen the relationship with your patients.
I hope you will enjoy SurgicalPerformance.