What Do the Patients Want and Worry in Korean Patients Who Undergo Arthroscopic Rotator Cuff Surgery?

BACKGROUND: To specify what patients want and worry preoperatively is important in orthopedic practice. The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery, and to evaluate the differences in expectations and concerns by age and gender. METHODS: We prospectively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008. Three questionnaires were completed before surgery: the first one addressing preoperative patient's expectation, the second one focusing on concerns by covering 64 items using a visual analogue scale, and the third one evaluating patient's demographic characteristics. The characteristics of preoperative expectation, concern, and demographic data were evaluated according to gender and age group. RESULTS: Female patients had lower level of sports activity (p = 0.007) and lower levels of information (p = 0.028). Gender specific worries are about a caregiver during hospital stay, operating on the working side, fear about ugly scars, postoperative pain, applying makeup or combing hair. The older group responded that they can't be willing to change activities of daily living (p = 0.001), are not living with a spouse (p = 0.002), had previous shoulder operation history (p = 0.008), and had a lower level of information (p = 0.007). They especially worried about medical bills, worried about the physician being too young and inexperienced, postoperative pain, loss of arm function, and hospital food. CONCLUSIONS: Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery. This can empower patients to formulate realistic expectations and make informed decisions. We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively.

Estresse em cirurgia de grande porte / Stress in major surgery

Este artigo tem como objetivo rever estudos sobre o estresse psicológico no perioperatório de pacientes adultos submetidos a operações de médio e grande porte, sob anestesia geral. Foram estudados trabalhos publicados e catalogados nas bases de dados Medline interface Pubmed, LILACS e Biblioteca Virtual de Saúde ? BVS desde 1984. Encontraram-se mais de 800 artigos relacionados a estresse e cirurgia, que foramanalisados em função de sua pertinência com o tema proposto. Desses, 18 abordaram o estresse psíquico. Os resultados levantados confirmaram a existência do estresse, tanto físico quanto psicológico, no período perioperatório e a relação entre estresse e evolução clínica de pacientes. Após a análise dos estudos observou-se a lacuna existentena literatura consultada, sobre a ação do estresse psíquico nesse período. O conhecimento mais aprofundado das implicações psicológicas do estresse pode beneficiar pacientes e profissionais de saúde no tratamento cirúrgico.

The purpose of this paper is to review studies on the perioperatory psychological stress in adult patients undergoing large and medium sized surgery, under general anesthesia. Papers published and catalogued in the database Medline interface Pubmed, LILACS and Biblioteca Virtual de Saúde-BVS (Health Virtual Library) were studied since 1984. Over 800 articles related to stress and surgery were found and analyzed due their pertinence with the proposed theme, among which 18 dealt with the psychical stress. The results confirmed the stress existence, either physical or psychological, in the perioperatory period, and the relation between the stress and the patientsï clinical evolution. After the studies analysis, the existing gap in the related literature was observed, concerning the psychical stress action in this period. The deeper information about the stress psychological implications may be beneficial both for patients and health professionals in the surgical treatment.