The journey to recovery after surgery represents a pivotal and demanding phase in a patient's healthcare experience. It is during the post-operative period that meticulous attention and proactive measures become paramount for ensuring a smooth recuperation while simultaneously reducing the risk of complications.

The adverse consequences of postoperative complications on patient health and mortality rates are palpable, making them a clear focal point for quality enhancement initiatives¹. General surgery patients frequently encounter these complications, leading to elevated mortality rates, prolonged hospital stays, and a heightened demand for post-discharge care¹.

This article aims to delve into four established strategies that hold the potential to substantially enhance positive post-operative outcomes, ultimately aiding patients in reclaiming their health and overall well-being.

Post-Operative Bedside Care in the Comfort of Your Own Home

The evolving landscape of healthcare has compelled a shift in focus from prolonged hospital stays to more streamlined care delivery within the comfort of patients' homes². Emerging from a body of clinical literature is the growing recognition of specialized home care, administered by advanced practice nurses (APNs), as an intervention that contributes to favourable postoperative outcomes for patients. A comprehensive 44-month comparative study², conducted with elderly patients recovering from surgical procedures related to cancer treatment, underscored the significance of specialized home care. This program, spanning four weeks post-surgery and comprising three in-home visits and five telephone consultations with an advanced nurse practitioner, demonstrated a noteworthy improvement in both patients' quality of life and their overall survival².

Moreover, this trend of augmented patient well-being and post-operative success extends beyond specific patient groups. A study conducted in 2007³ focused on women who had undergone major abdominal or pelvic surgery for benign gynecological conditions, highlighting the advantages of early discharge with the support of a specialist nurse. This approach not only resulted in significantly reduced hospital stays and associated costs but also bore no adverse physical or psychological effects on patients, further underscoring the cost-effectiveness of specialist nurse-assisted discharges in the realm of healthcare³.

Remote Patient Monitoring: Post-Operative Check-ins in the Palm of Your Hand

While patients receive continuous monitoring by clinical teams during their hospital recovery following major surgery, their situation changes once they are discharged. After leaving the hospital, they undergo the rest of their recovery in isolation at home, with limited interaction with the clinical team⁴. The initial 30 days back home post-surgery are recognized as a critical and challenging period for patients, impacting them emotionally, practically, and mentally. Additionally, this period poses a significant risk of further complications, readmission, and potentially even surgical-related mortality⁴. Remote Patient Monitoring (RPM) systems show great promise in enabling clinicians to provide remote care and support for patients⁴.

A 2022 study⁵ of a remote patient monitoring platform, designed for post-operative care of patients who had undergone spinal surgery found high patient and medical practitioner adherence to the digital platform resulted in increased communication, consistent providence of patient data, and other benefits, such as patient weight-loss through digitized communication with other healthcare providers, such as remote nutritionists. The integration of this platform proved efficacious in the detection and management of postoperative issues, reducing the necessity for unscheduled in-person visits; providing a convenient and reliable option for patient care⁵. Overall, patients expressed high satisfaction and felt secure using the remote monitoring platform⁵.

A 2023 study⁶, focused on digitalized patient monitoring for inguinal hernia repair postoperative care demonstrated similar efficacies in remote patient monitoring technology as a means of continued communication and reporting for postoperative patients and healthcare providers⁶. Research indicated amongst patients who used the remote monitoring application, 44 reported no postoperative deviations, with 93.2% of these cases aligning with standard follow-up findings. The study also demonstrated high patient satisfaction, with an average patient rating of 4.2 on a Likert scale of 1-5; indicating the strong potential and willingness amongst patients to use a digital application for follow-up care. Researchers concluded remote postoperative monitoring applications present a promising tool for identifying patients who require in-person or phone-based follow-up assessments, and could potentially enhance the safety and quality of postoperative care.

Good Laughs & Great Music: What Holistic Approaches Teach Us About Post-Operative Recovery Routines

Exploring less traditional approaches to ensuring optimal postoperative outcomes, there is growing literature on how various meditative techniques and other psycho-social interventions may be beneficial elements in a holistic approach to post-operative patient care. A 2023 study⁷ explored the impact of music and comedic films as interventions on postoperative pain and kinesiophobia in patients who had undergone total knee arthroplasty (TKA). The randomized-controlled study divided patients in group groups: Group 1 watched a comedy movie, Group 2 listened to music, and Group 3 did not receive any intervention beyond standard clinic practices⁷. The patients across all groups had similar personal and medical characteristics, despite pharmaceutical interventions, all three groups experienced moderate surgical pain levels and displayed kinesiophobia⁷. However, Groups 1 and 2 exhibited statistically significant reductions in kinesiophobia and pain scores following their respective interventions⁷. Interestingly, the effects of having patients watch a comedy movie and having them listen to meditation music did not significantly differ⁷. The study's findings indicated that both listening to meditation music and watching comedy movie scenes had substantial positive effects in mitigating postoperative pain and kinesiophobia following TKA⁷.

Hypochlorous Acid: One Solution, Multiple Post-Operative Applications

Post-operative infections are a serious complication that can impact the surgical site and surrounding skin. The utilization of hypochlorous acid (HOCl) and its impact on postoperative outcomes continues to grow in clinical literature. Here we review four studies, demonstrating the efficacy and safety of hypochlorous acid for post-operative care.

Hypochlorous Acid & Skin Grafts

For successful skin grafting procedures, physicians frequently utilize antimicrobial irrigants to prevent surgical site infection⁸. A safe, efficacious, and cost-effective irrigant capable of preventing infections would be a valuable adjunctive therapy. In a 2019 study⁸, patients with burns requiring skin grafting were randomized to a hypochlorous acid or 5% Sulfaymylon solution group for post-operative dressing. The objective of the study was to determine whether hypochlorous acid would bolster comparable results to current therapy (5% Sulfaymylon) in controlling infection and reducing postoperative pain in patients with skin grafts⁸. Researchers found treatment groups were demographically equivalent, and there were no differences or adverse events between the two patient groups⁸. Graft viability and infection rates were equivalent, and pain scores and narcotic usage were similar⁸. However, hypochlorous acid was found to be significantly less expensive than standardized therapy with the 5% Sulfaymylon solution⁸.

Hypochlorous Acid & Postoperative Intrauterine Infection Following Microwave Endometrial Ablation (MEA)

In a 2020 study⁹, Tsuda and Kanaoka investigated the use of hypochlorous acid water to prevent postoperative intrauterine infection following microwave endometrial ablation, a medical procedure used in gynecology. Over four-hundred patients were split into two groups: Group A, consisting of patients treated using the standardized protocol of povidone-iodine antiseptic solution and Group B, who received the additional intrauterine cleaning using HOCl (hypochlorous acid)⁹. Both groups received one gram of Ceftriaxone Sodium Hydrate through intravenous drip during the microwave endometrial ablation (MEA) procedure⁹. However, only patients in Group A received oral antibiotics after the MEA, while those in Group B did not⁹.

Researchers found in Group B, which received intrauterine cleaning with HOCl, experienced significantly fewer cases of postoperative intrauterine infection (8 cases) compared to Group A (28 cases), as confirmed by statistical analysis (Chi-square test, P = 0.001)⁹. In Group A, three patients with severe intrauterine infection had to undergo a hysterectomy, while no such severe infections were observed in Group B⁹. Importantly, no adverse effects were observed due to the use of HClO.The researchers concluded that Intrauterine cleansing using HOCl decreases postoperative intrauterine infection after MEA⁹.

Hypochlorous Acid in Pre- and Post-operative Chronic Wound Care

Hypochlorous acid has been shown to effectively reduce bacterial levels present in open wounds¹⁰, compelling researchers to test the solution’s antimicrobial effects as a solution in wound debridement. This 2016 study¹º compared the effectiveness of ultrasound debridement with hypochlorous acid versus saline for cleaning pre- and postoperative chronic wounds and monitored bacterial regrowth over one week. The study also recorded the outcome of definitively closing clinically clean-appearing wounds. Seventeen patients with open, chronic wounds were divided into two groups, one receiving hypochlorous acid irrigation, and the other receiving saline irrigation. Tissue samples were collected from all patients before and after the procedure to analyze bacteria qualitatively and quantitatively. The wounds were dressed with silver-impregnated and hydroconductive dressings for seven days between the debridement and closure. Results showed that both types of irrigation in the ultrasonic system initially reduced bacterial counts significantly¹º. However, by the time of definitive closure, the saline-irrigated wounds had bacterial counts return to 105, whereas the hypochlorous acid-irrigated wounds maintained counts of 102 or fewer¹º. Postoperative wound closure failure occurred in more than 80% of patients in the saline group, while only 25% of patients in the hypochlorous acid group experienced such issues¹º. Researchers concluded using hypochlorous acid irrigation with ultrasound debridement was more efficient in reducing bacterial growth in chronic open wounds compared to saline alone¹º. The postoperative wound closure outcomes suggested a substantial reduction in wound complications when using hypochlorous acid with ultrasound for debridement compared to saline alone¹º.

Hypochlorous Acid & Neonatal Circumcision

In this 2022 study¹¹, researchers compared hypochlorous acid (HOCl) and povidone-iodine (PI) as disinfectants for neonatal circumcisions. The study included sixty infants who underwent neonatal circumcision. Patients were divided into two groups based on the disinfectant used: Group 1 included 28 patients treated with HOCl, and Group 2 included 32 patients treated with PI¹¹. Upon examination of individual complications, researchers found there were no significant differences between the two compassion groups¹¹. However, upon collective analysis of post-procedure complications, it was found that Group 2 had a higher complication rate (p = 0.037)¹¹. Specifically, the incidence of edema and delayed wound healing in Group 2 was significantly higher than in Group 1 (p = 0.037 and p = 0.036, respectively)¹¹. Researchers concluded that HOCl is a reliable disinfectant for neonatal circumcisions and may be related to fewer post-procedural complications¹¹.

Final Thoughts

In conclusion, the ever-evolving landscape of healthcare is witnessing a transformative shift towards more patient-centric and holistic approaches to post-operative care¹⁻¹¹. Specialized home care administered by advanced practice nurses has demonstrated remarkable improvements in patients' quality of life and overall survival, underlining its significance in healthcare²⁻³.

Additionally, the integration of digitalized remote patient monitoring technologies has shown immense promise in providing continuous care and support, reducing the need for unscheduled in-person visits and enhancing the safety and quality of postoperative care⁴⁻⁶. Furthermore, unconventional yet effective interventions like meditative music and comedic films have proven their worth in mitigating postoperative pain⁷. Lastly, the increasing focus on hypochlorous acid in post-operative care has yielded positive results in preventing infections and reducing costs, further enriching the array of tools available for healthcare practitioners⁸⁻¹¹.

These multifaceted approaches exemplify the dynamic and innovative nature of modern healthcare, striving to optimize post-operative outcomes and improve patients' overall well-being.