The impact of quality of sleep on recovery from fast-track abdominal hysterectomy

Abstract

Study objectives: To examine the impact of mode of anesthesia on perceived quality of sleep and to analyze the perceived quality of sleep in affecting recovery from surgery.

Methods: A randomized, controlled, open multicenter trial was conducted in 5 hospitals in Southeast Sweden. One-hundred eighty women scheduled for fast-track abdominal hysterectomy for benign conditions were randomized to spinal anesthesia or general anesthesia; 162 women completed the trial; 82 allocated to spinal anesthesia and 80 to general anesthesia. Symptoms and perceived quality of sleep after surgery were registered daily in the Swedish Postoperative Symptoms Questionnaire.

Results: Women in the general anesthesia group experienced bad quality of sleep the night after surgery significantly more often than the women who had spinal anesthesia (odds ratio [OR] 2.45; p = 0.03). This was almost exclusively attributed to a significantly higher consumption of opioids postoperatively in the general anesthesia group. Risk factors for bad quality of sleep during the first night postoperatively were: opioids (OR 1.07; p = 0.03); rescue antiemetics (OR 2.45; p = 0.05); relative weight gain (OR 1.47; p = 0.04); summary score of postoperative symptoms (OR 1.13; p = 0.02); and stress coping capacity (OR 0.98; p = 0.01). A longer hospital stay was strongly associated with a poorer quality of sleep the first night postoperatively (p = 0.002).

Conclusions: The quality of sleep the first night after abdominal hysterectomy is an important factor for recovery. In fast-track abdominal hysterectomy, it seems important to use anesthesia and multimodal analgesia reducing the need for opioids postoperatively and to use strategies that diminish other factors that may interfere negatively with sleep. Efforts to enhance quality of sleep postoperatively by means of preventive measures and treatment of sleep disturbances should be included in fast-track programs.

Trial registration: ClinicalTrials.gov NCT00527332.

Keywords: Abdominal hysterectomy; fast track; general anesthesia; postoperative recovery; quality of sleep; spinal anesthesia.

Figure 1. Summary of the fast-track program and anesthesia

5-HT₃, 5-hydroxytryptamine type 3; IV, intravenous; PONV, postoperative nausea and vomiting; PACU, post anesthesia care unit; VAS, visual analogue scale.

Figure 2. Associations between the quality of sleep the night after surgery and duration of hospital stay and sick leave

Boxes represent mean and error bars represent SD; p-values represent results of Fisher PLSD post hoc tests.