Patient expectations shape convalescence after major liver surgery – A prospective, randomized study. (October 2021) - Börner, Nikolaus
Abstract: Background: Several studies suggest an important influence of patient expectations on outcomes. We hypothesized that patient expectations with regard to length of postoperative stay influence convalescence after liver resections. Method: This prospective, randomized study compared patients who were preoperatively either informed to be expected to stay 7–10 days (short arm) or 12–16 days (long arm) after major liver resections (≥4 segments). Additionally, psychological traits were assessed using questionnaires and the time to fulfillment of objective discharge criteria [oral analgesics only, first bowel movement, ability to tolerate solid food, full mobilization, no complications which need general anesthesia (>CD IIIa)] was defined as the primary endpoint. Results: Patients in the short arm reached the objective discharge criteria after 8.39 days (SD 3.60), while patients in the long arm needed 12.73 days (SD 3.43) (p = 0.001). The actual length of stay in the short arm was 12.00 (IQR 8–16) and 19.3 days in the long arm (IQR 14–26) (p = 0.008). A more pronounced self-efficacy correlated with earlier fulfillment of the objective discharge criteria (p = 0.048), whereas patients placing a high value on their health needed more time (p = 0.049). Conclusion: The expectation of a shorter length of stay results in a quicker objective, physical patient convalescence after major liver resections. Highlights: Prospective, randomized trial on patients with major hepatectomy. Preoperatively, patients were told about an anticipated length of stay of either 7-10 (short arm) or 12-16 days (long arm). Patients in the short arm recovered quantifiably quicker. Patients in the short arm left the hospital earlier than those in the long arm.