Science in a flash: pain, anxiety, stress and sleep disturbances among surgical patients

How often do surgical patients experience pain, anxiety, stress, and sleep disturbance during their hospital stay? And how severe are these symptoms? In collaboration with numerous Dutch hospitals, we set out to answer these questions, using an uncommon and innovative, but for our goals perfectly fitting method: a flash mob study.

A flash mob study is a novel research design in which data is collected on a single day, simultaneously in multiple centres. It’s an efficient way to address clinically relevant questions on a large scale – in our case the point prevalence of surgical patient pain, anxiety, stress, and sleep disturbance. But this approach also requires meticulous planning: there’s only one shot to get it right.

The preparation for the project took a year. We started by developing the methodology and drafting the study protocol, followed by compiling all necessary documents for submission to the Medical Ethics Review Committee (MERC). While awaiting approval, we reached out to all hospitals across the Netherlands. Through secretaries and outpatient clinics, we found surgeons and residents in 29 Dutch hospitals who were eager to participate and helped forming a local research team and arranging institutional approval from the hospital board.

As the coordinating researchers, we then traveled across the country to visit each participating hospital. We delivered study materials, including consent forms, questionnaires, posters, and flyers, and trained the local teams on study procedures. These visits proved highly valuable: while initial communication had been through email and video calls, meeting in person significantly boosted enthusiasm and commitment.

On the study date, a total of 733 patients participated in the study and completed the questionnaire on patient-reported outcomes. The results showed that 70% of surgical patients reported pain, 38% reported anxiety and stress, 64% reported sleep disturbance.1 These numbers are particularly striking when compared to classic complications such as infection, anastomotic leakage or postoperative haemorrhage which occur in ‘only’ 7-15% of patients who undergo major surgery.2-4 These ‘classic’ complications are monitored closely, and treated timely and adequately given their impact on the patient’s recovery. However, the acknowledgement and treatment of pain, anxiety, stress, and sleep disturbance demand equal attention.

Unfortunately, these patient-reported outcomes are generally considered to be ‘normal’ or even ‘unavoidable’ events during hospitalization. We do not argue that obviously they go hand in hand with surgery and hospital admission: pain from the procedure; anxiety about the anaesthesia; stress about the surgery and its outcomes; poor sleep due to an uncomfortable bed, hospital noise and interruptions. Although these complications are expected to some extent in the context of a surgical procedure requiring hospitalization, they still warrant careful monitoring and appropriate management. The high prevalence and the known negative consequences of these complications, for example prolonged hospital stay, cardiovascular events, postoperative delirium, development of chronic pain underscore the need for adequate treatment even more.5-7 To minimize, or possibly prevent side-effects from pharmacological agents, we strongly advocate for the implementation of non-pharmacological interventions to complement standard protocols in perioperative care.