Our study shows that outpatients in Zhejiang Hospital have relatively high levels of worries about day surgery, similar to previous studies in mainland China. 84.5% of respondents were worried about perioperative periods of day surgery, which was perceived as an innovative medical service in mainland China. Yu Deliang proposed that patients and families generally required a high level of professional nursing care during the postoperative period. However, such a high level of care may be absent in the outpatient setting, therefore, patients and their families undergoing day surgery may worry.[14] According to a survey in a Shanghai community, residents' perceptions of day surgery were poor, more than 70% of community residents had doubts about day surgery.[10] An investigation in West China Hospital showed that more than 60% of patients undergoing day surgery did not understand the concept of day surgery, including how it works and its values.[11] However, those studies did not explore which population is at risk of being worried. In our study, we identified several risk factors. Patients who were older and had more systemic diseases tend to worry more in the day surgery setting. This is consistent with a Swedish study showing that older patients had more concerns about anesthesia and surgery during day surgery. Also, lower levels of education and worse economic status lead to more worries. Therefore, we suggest hospitals establish a standardized process to screen out patients who may have more worries, and develop strategies for this targeted patient population.
Moreover, we comprehensively investigated the specific reasons for patients’ concerns. Before receiving any day surgery, outpatients worried about both preoperative and postoperative periods, and the worries covered almost all possible aspects of preoperative preparation, transportation and accommodation, rehabilitation, healthcare payment, etc. That is, outpatients believe when they are not in the hospital, it is difficult to obtain professional guidance and relevant information in time, which suggests that an effective perioperative communication mechanism between doctors and patients is absent. Studies in France and America focusing on perioperative communication channels suggested that better doctor-patient communication is correlated with higher patient satisfaction and better outcomes.[15-17] Similarly, studies in mainland China also indicated that establishing a good communication channel could promote doctor-patient communication, thus reducing patients’ perioperative worries.[18] Nanjing Drum Tower Hospital applied extended nursing management during the perioperative period for patients undergoing laparoscopic day-surgery, based on the WeChat platform- one of the most popular instant messengers in mainland China, relieved the anxiety of patients effectively.[19] For those reasons, it is significant to establish a convenient, immediate and effective doctor-patient communication mechanism when patients are outside the hospital.
Patient acceptance of day surgery in our study is different from both domestic and foreign studies, the proportion of outpatients willing to undergo day surgery (scores 7-10) was 35.2%. While a study by Dai Yan in Sichuan Province showed that 94.5% of day-surgery patients are open to day surgery in 2016,[11] yet a recent survey in 2019 revealed that 24.88% of residents in a Shanghai community accept day surgery.[10] These diversified results may derive from different samples in those studies and unbalanced development of day surgery across China. Furthermore, compared to western countries where day surgery is highly popular, Zhejiang outpatients’ acceptance of day surgery is fairly low. Given that people’s attitude towards a medical practice has much to do with the development time of the medical service, healthcare insurance system, medical technology, and national health literacy,[20] patients’ different attitudes may originate from the differences in above all aspects between China and developed countries.
The multivariate analysis revealed that patient acceptance of day surgery in this study was related to a variety of personal factors, suggesting that patients with younger age, higher education, no underlying disease, and better financial ability are more likely to accept the concept of day surgery. These findings raised a possibility that with the improvement of national education level, physical quality and economic ability, Chinese patients will gradually be more open-minded about day surgery. Besides, surgery type also affects patient acceptance of day surgery. For example, orthopedic outpatients are relatively more reluctant to take operations as day surgery, we consider this may result from Chinese patients’ traditional thinking that patients should have a full recovery in the hospital. Orthopedic surgeries are perceived as extensive and complex, patients undergoing orthopedic surgeries think they should recover in the hospital, not in the day surgery setting. Under such circumstances, hospitals should improve patient education according to Chinese patients’ characteristics to promote day surgery.
Although there are studies focusing on patients’ worries and patient acceptance of day surgery, the possible association between them is blurred. Our study implies that patient acceptance of day surgery is influenced by their perioperative worries. In other words, patients who had fewer worries had a higher level of acceptance of day surgery. Accordingly, sufficient doctor-patient communication and interaction need to be guaranteed by strengthening perioperative systems of day surgery, focusing on building communication channels to provide patients timely, effective and professional guidance, so that to dispel worries of patients during the perioperative period, thereby increase patient acceptance of day surgery.
Limitations
The major drawback of the study lies in the sample taken from one center. Nevertheless, whether other patients like inpatients and patients who have experienced day surgery are of the same situation needs further investigation. Moreover, more researches are warranted not only in Zhejiang province but also across China to provide more evidence for present patient attitude towards day surgery in mainland China. Second, we used a subjective method to assess the patient acceptance of day surgery, similar to previous studies that also utilized various subjective evaluations. However, whether those subjective methods are reliable and valid need further proof. Third, future studies could investigate how to establish an effective doctor-patient communication mechanism to address patient worries during perioperative periods so that to increase patient acceptance of day surgery.