Gillian Waitzman
Pronouns: She/her/hers
Research Mentor(s): Sydney Brown
Research Mentor School/College/Department: Anesthesiology / Medicine
Program: UROP
Session: Session 6 (3:40pm – 4:30pm)
Authors: Gillian Waitzman, Sydney Brown
Abstract
Title: Adverse Outcomes Most Relevant to Adolescents Following Outpatient Elective Surgery Background: Patients commonly experience adverse outcomes such as pain, nausea, fatigue, sleep disturbance, mood dysregulation, and cognitive impairment after elective outpatient surgeries. However, it is unclear which symptoms are most bothersome to adolescents having outpatient elective surgery, whether there are variables that may mitigate the experience of adverse symptoms, and whether there is consistency between patient and parent reporting of symptoms. Minimal literature exists that has elicited which symptoms matter most to adolescents from adolescents themselves after surgery. Methods: We conducted semi-structured interviews with children 12-17 years old undergoing elective outpatient surgery (n=31) and one of their parents (n=31). Parents and patients were interviewed separately about the effect of recovery on the child’s quality of life, independence, and physical, mental, and social health. Interviews were conducted over telephone or video conferencing approximately two weeks after each surgery. We used content analysis concurrent with data collection to identify themes. Interviews were coded by two independent reviewers, with relevant quotes identified and data summarized using NVivo software. Results: Participant ages were evenly distributed with a median age of 15 years. The majority were White, six were Black, two were Hispanic, and one was Middle Eastern. The most common surgeries were ear, nose, and throat surgeries such as tonsillectomy and adenoidectomy, tympanoplasty (n=7); orthopedic surgeries such as arthroscopies, foot and ankle surgery, and hardware removal (n=5); plastic surgeries such as scar revision, mole excisions, and laser treatment (n=6); and general surgeries including mass excision, port removal, and cholecystectomy (n=4). Six patients received sedation with a natural airway; the remainder received general anesthesia with a laryngeal mask airway or endotracheal tube. A minority (n=13) received triple antiemetic therapy and all but two patients received at least one opioid intraoperatively. Commonly reported postoperative complaints included severe fatigue (lasting 1-12 days and requiring 12+ hours of sleep per day) and sleep disruption due to pain or having to sleep in an uncomfortable position. Many patients experienced nausea on the day after surgery, with some reporting vomiting for 3-5 days. Patients undergoing more invasive surgeries (orthopedic, tonsillectomy and adenoidectomy) needed help with activities like getting dressed, going to the bathroom, and preparing meals. Reports of frustration, anxiety, sadness, and sometimes anger were associated with the speed of recovery or their inability to see friends and engage in recreational activities. Patients and parents derived optimism from meeting milestones with physical therapy, having friends and loved ones come to visit, and resuming regular activities. Conclusions: Despite differences in personal factors including age, race, and type of surgery undergone, patients reported general commonalities in physical symptoms like fatigue and nausea. Furthermore, interviews with patients and their parents suggested that recovering from outpatient elective surgeries can also significantly impact an adolescent’s emotional and social wellbeing due to limitations placed on their regular activities and routines. Significance: Greater exposure to, and understanding of, the adverse outcomes that pediatric patients undergo following outpatient elective surgery opens up new opportunities for research and adjustments in perioperative interventions that can help improve their recovery experience.
