Abstract
This study investigates the interplay between plastic and reconstructive surgery patients and their respective caregivers in the Day Surgery Unit of Policlinico Umberto I, Rome, Italy. Utilizing a dual survey approach, we explored the role in patient safety and the challenges faced by caregivers during the perioperative period. This study, conducted at Policlinico Umberto I, covers all surgical procedures from October to December 2023, encompassing skin cancer removal, fat grafting, scar revisions, hand surgeries, and eyelid surgeries. Patient demographics reflect varying age distributions: 18-39 (4.9%), 40-59 (31.7%), 60-75 (34.1%), and over 76 years (29.3%).
Keywords: Caregiver, Day surgery, Plastic surgery, Reconstructive Surgery, Safety
Background
Day surgery (DS) units have become integral in healthcare, offering streamlined solutions for patients requiring elective plastic and reconstructive surgery interventions.1 DS aims to simplify access to services, ensuring faster healthcare response times and reducing waiting lists.2,3 DS units also alleviate psychological and social burdens on patients and their families by reducing hospital stay duration and mitigate complications associated with prolonged hospitalization, particularly for infectionsrelated to care.2,3 It rationalizes hospital care organization and contains costs by promoting clinical-organizational appropriateness, ensuring quality, efficacy, efficiency, and treatment safety, and optimizes resource utilization.2,3 In general, eligible procedures are elective, of medium-short duration, and have a low incidence of complications.3,4 Patients eligible for DS include those in good general condition (American Society of Anesthesiology (ASA) Class I) or with minor systemic illnesses (ASA Class II). Obesity (Class II-III) is a contraindication. Age is not a barrier, except for children under 6 months. Generally, ineligible patients encompass those with chronic conditions in acute exacerbation, recovering from severe acute illnesses, undergoing investigations for other conditions, and those requiring continuous oxygen therapy.2,4, 5, 6, 7 Eligible patients must comprehend and accept the procedure, adhere to prescriptions, maintain post-operative hygiene and possess a telephone.2, 3, 4 Patients should also have a responsible adult to accompany them home and remain with them for 24 hours after surgery,2, 3, 4 thereby, making the caregiver an essential part of the DS process. This study delved into the various aspects of caregiver involvement and its impact on the patient and caregiver experiences to investigate the multifaceted roles of caregivers in DS units for plastic and reconstructive surgery patients.
Materials and Methods
For this study, a dual survey approach was conducted that involved 42 patients who underwent plastic and reconstructive surgery in the DS unit and their respective caregivers. Patients were recruited based on the surgical procedures performed at the Policlinico Umberto I DS Unit from October to December 2023, covering skin tumor excisions and reconstruction with skin grafts or local flaps, fat grafting, scar revision, hand surgery, and eyelid surgery (Table 1). According to the patient demographics the age distributions were 18-39 (4.9%), 40-59 (31.7%), 60-75 (34.1%), and over 76 years (29.3%) (Table 2).
Table 1.
Surgeries performed between October to December 2023 at Policlinico Umberto I DH unit.
| Surgery Performed | Percentage |
|---|---|
| Tumor excision and reconstruction with graft or local flap | 56.2% |
| Fat grafting | 22.0% |
| Scar revisions | 9.8% |
| Hand surgery | 7.2% |
| Eyelid surgery | 4.8% |
Table 2.
Age demographics.
| Age Group (years) | Percentage |
|---|---|
| 18-39 | 4.9% |
| 40-59 | 31.7% |
| 60-75 | 34.1% |
| Over 76 | 29.3% |
Patient Survey Questions:
Participants were asked the following questions:
1a. What is your relationship with your caregiver?
2a. Did you experience any disturbances while returning home after discharge that required intervention from the caregiver?
3a. Did you require assistance from your caregiver in the first 24 hours following the procedure?
4a. And after the first 24 hours?
5a. Did you require assistance beyond the caregiver's capabilities?
6a. From a psychological standpoint, was it helpful to have the caregiver's support?
7a. In your experience, did the day surgery process meet the safety expectations?
8a. How much did the presence of the caregiver influence this?
Caregiver Survey Questions:
Caregivers were asked the following questions:
1b. Was your help needed during the journey back home?
2b. Was your assistance required in the first 24 hours after the procedure?
3b. And after the first 24 hours?
4b. In the post-operative period at home, were there situations that caused you concern and required you to make challenging decisions?
5b. Were the medical instructions clear?
Results
The patient's survey responses were analyzed to understand the patient demographics, relationships with caregivers, post-operative disturbances, required assistance, psychological impacts, safety expectations, and the influence of caregivers on perceived safety. The caregiver survey responses were analyzed to explore their experiences, challenges, and decision-making during the post-operative care period.
Summary of the responses to the patient's survey question:
1a. What is your relationship with your caregiver? Friend: 2.4%, spouse: 48.8%, children: 31.7%, sibling: 9.8%, parent: 2.4%, nephew: 2.4%, and son-in-law: 2.4%. Most patients reported their spouse as the primary caregiver, highlighting the crucial role of family support in this setting..
2a. Did you experience any disturbances while returning home after discharge that required intervention from the caregiver? No: 58.5%, Yes: 41.5% (Table 3). A significant portion of patients reported experiencing disturbances during their journey home, underscoring the crucial role of the caregiver in facing the potential challenges in the immediate post-operative period.
Table 3.
Patient survey questions 1a to 6a and related answers.
| Survey Question | No | Yes |
|---|---|---|
| 2a - Did you experience any disturbances while returning home after discharge that required intervention from the caregiver? | 58.5% | 41.5% |
| 3a - Did you require assistance from your caregiver in the first 24 hours following the procedure? | 51.2% | 48.8% |
| 4a - And after the first 24 hours? | 63.4% | 36.6% |
| 5a - Did you require assistance beyond the caregiver's capabilities? | 97.6% | 2.4% |
| 6a - From a psychological standpoint, was it helpful to have the caregiver's support? | 2.4% | 97.6% |
3a. Did you require assistance from your caregiver in the first 24 hours following the procedure? No: 51.2%, Yes: 48.8% (Table 3). Nearly half of the patients required assistance within the initial 24 hours, indicating the importance of caregiver support during the early stages of recovery.
4a. And after the first 24 hours? No: 63.4%, Yes: 36.6% (Table 3). Although a majority of patients were independent after the initial 24 hours, a significant portion continued to rely on assistance in the subsequent recovery period.
5a. Did you require assistance beyond the caregiver's capabilities? No: 97.6%, Yes: 2.4% (Table 3). An overwhelming majority of patients reported that their caregivers were capable of providing the necessary assistance, reflecting a well-aligned support system.
6a. From a psychological standpoint, was it helpful to have the caregiver's support? No: 2.4%, Yes: 97.6% (Table 3). The vast majority found psychological support in having a caregiver, emphasizing the emotional benefits of their presence during the recovery process.
7a. In your experience, did the day surgery process meet the safety expectations? Ratings on a scale of 0-5: 0: 0%, 1: 0%, 2: 0%, 3: 0%, 4: 17.1%, and 5: 82.9% (Figure 1). Most patients rated the DS process as being highly safe, with over 80% giving a maximum score of 5.
Figure 1.
Patient survey questions 7a to 8a and related answers.
8a. How much did the presence of the caregiver influence this? Ratings on a scale of 0-5: 0: 0%, 1: 0%, 2: 0%, 3: 4.9%, 4: 51.2%, and 5: 43.9% (Figure 1). Patient perceptions of safety were significantly influenced by the presence of caregivers, with more half of them providing a score of 4 or 5.
Summary of responses to the caregiver's survey questions:
1b. Was your help needed during the journey back home? No: 15%, Yes: 85% (Table 4). The majority of caregivers played an active role during the journey back home, indicating the necessity of their assistance in this transitional period.
Table 4.
Caregiver survey questions 1b to 5b and related answers.
| Survey Question | No | Yes |
|---|---|---|
| 1b - Was your help needed during the journey back home? | 15% | 85% |
| 2b - Was your assistance required in the first 24 hours after the procedure? | 54% | 46% |
| 3b - And after the first 24 hours? | 61% | 39% |
| 4b - In the post-operative period at home, were there situations that caused you concern and required you to make challenging decisions? | 100% | 0% |
| 5b - Were the medical instructions clear? | 0% | 100% |
2b. Was your assistance required in the first 24 hours after the procedure? No: 54%, Yes: 46% (Table 4). A balanced distribution suggests that nearly half of the caregivers were involved in assisting the patients within the initial 24 hours, reflecting a shared responsibility in early post-operative care.
3b. And after the first 24 hours? No: 61%, Yes: 39% (Table 4). A significant portion of the caregivers continued to be involved in patient care beyond the initial 24 hours, highlighting the sustained need for their assistance in the recovery process.
4b. In the post-operative period at home, were there situations that caused you concern and required you to make challenging decisions? No: 100%, Yes: 0% (Table 4). The absence of reported concerns and challenging decisions indicates that caregivers were able to meet the patients’ needs, with no demand of medical support.
5b. Were the medical instructions clear? No: 0%, Yes: 100% (Table 4). All caregivers reported clarity in understanding the medical instructions, emphasizing the importance of effective communication between healthcare providers and caregivers for seamless post-operative care.
Discussion
With an aging population, the demand for healthcare increases, while health care budgets and manpower lag behind.8 Consequently, even in countries that currently have a large publicly funded healthcare sector, such as Italy, informal care is becoming increasingly important. The survey results shed light on the intricate dynamics between patients and caregivers in the plastic and reconstructive surgery DS unit. Patients overwhelmingly identified spouses as the primary caregivers (48.8%), emphasizing the vital role of marital support. The diverse roles of caregivers, including spouses (48.8%), children (31.7%), and siblings (9.8%), underscore the varied familial support structures crucial for patient well-being during the perioperative period. According to our survey, patients reported experiencing disturbances during the journey home (41.5%), underscoring the need for caregiver support. This aligns with caregiver reports, where 46% actively provided assistance, especially in the crucial first 24 hours post-operatively. Although 63.4% became independent after the initial 24 hours, 36.6% of patients continued to require assistance, emphasizing the evolving role of caregivers throughout the recovery process. Patients found substantial psychological benefit in having a caregiver (97.6%), highlighting the emotional support provided during the challenging post-operative period. This resonates with the caregiver reports, where the absence of reported concerns and challenging decisions suggests a positive caregiving experience. Caregiver burden is defined as the psychosocial and physical reaction to the imbalance of demands placed on the caregiver by various factors, including personal time, multiple roles, physical and emotional states, financial resources, and formal care resources.9. Several studies have highlighted how caregivers commonly face role conflict and inadequate stress management.10, 11, 12, 13, 14, 15, 16 Our study places the responsibilities faced by caregivers in the DS unit into context, emphasizing that these challenges were not burdensome for them, particularly when aided by clear medical instructions for post-operative care. Furthermore, patient perceptions on the DS process meeting safety expectations were overwhelmingly positive, with the caregivers playing a significant role in influencing these perceptions. The close correlation between patient ratings and caregiver influence underscores, once again, the pivotal role played by the caregivers in shaping patients' perceptions of safety.
Conclusion
Our study underscores the crucial role of informal caregivers in the plastic and reconstructive DS units by ensuring patient safety and avoiding inadequate hospitalization. In the face of an aging population and growing healthcare demands, these caregivers emerge as vital supporters during the perioperative period. Our findings highlight the significance of familial support in creating a positive post-operative experience. Importantly, the study also reveals a lack of caregiver burden, showcasing their seamless integration into this specialized unit, especially when given clear medical instructions. The positive correlation between patient ratings and caregiver influence emphasizes the pivotal role of informal caregivers in shaping safety perceptions of the patients. In conclusion, our study empowers caregivers, positioning them as effective contributors to patient care.
Conflict of Interest
None.
Acknowledgments
Ethical Approval
Not required.
Funding
None.
References
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