Evaluating surgical patient experiences and clinical outcomes

This thesis explores the significance of patient-centred care in modern surgical practice, focusing on both general and cardiac surgery. Patient-centred care prioritises the patient’s beliefs, values, and experiences, aiming to improve not only traditional clinical outcomes—such as mortality, complications, and technical performance—but also patient-reported outcomes (PROs) like pain, health-related quality of life (HRQoL), and emotional well-being. The introduction highlights that while clinical metrics are well established, PROs remain underutilised, especially in cardiac surgery, despite their importance in capturing the long-term challenges patients face after surgery.
The thesis is divided into two main parts. The first part examines chronic post-surgical pain management, particularly the use of neuromodulation techniques such as spinal cord and dorsal root ganglion stimulation. These studies assess both clinical and patient-reported outcomes, demonstrating the value of integrating PROs to evaluate the effectiveness and sustainability of pain management strategies.
The second part focuses on cardiac surgery, with special attention to perioperative coagulation management in patients with infective endocarditis (IE) and the use of PROs in patients undergoing thoracic aortic surgery. Surveys and registry analyses reveal significant variation in clinical practice and underscore the need for standardised protocols and better preoperative management. Studies on aortic surgery patients show that survivors face persistent physical, mental, and social challenges, reinforcing the necessity of including PROs in surgical evaluation.
Overall, the thesis advocates for a shift towards more personalised, patient-centred surgical care, aligning clinical success with patient-defined goals and long-term quality of life.