Tung T Tran1, Pepa Kaneva2, Nancy E Mayo3, Gerald M Fried1, Liane S Feldman4. 1. Department of Surgery, McGill University, Montreal, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Canada. 2. Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Canada. 3. Division of Clinical Epidemiology, McGill University, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada. 4. Department of Surgery, McGill University, Montreal, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Canada. Electronic address: liane.feldman@mcgill.ca.
Abstract
BACKGROUND: Although duration of hospital stay commonly is used as a surrogate outcome for surgical recovery, it is not applicable in the setting of short-stay surgery (<24 hours). The objective of our study was to describe the trajectory of recovery after short-stay abdominal surgery by using measures of physical activity and health-related quality of life (HRQL) and identify predictors of prolonged, postdischarge recovery. METHODS: Patients undergoing short-stay abdominal surgery were evaluated preoperatively and at 3 weeks and 2 months postoperatively. Physical activity was assessed with a validated questionnaire (Community Health Activities Model Program for Seniors, ie, CHAMPS) in which patients report physical activity for the previous week; responses estimate total weekly caloric expenditure (kcal/kg/wk). The Medical Outcomes Study 36-Item Short-Form Health survey (SF-36) was used to assess HRQL. Multivariate logistic regression was performed to determine which variables were predictive of recovery to baseline physical activity levels. RESULTS: A total of 132 patients (71% male, 53 [15] years) participated; 91% were discharged on the day of surgery. The most common procedures were open inguinal herniorrhaphy (40%) and laparoscopic cholecystectomy (30%). As a group, total, self-reported physical activity and most domains of HRQL were recovered to or greater than baseline at 3 weeks postoperatively and were above baseline levels at 2 months (P < .01). Patients who were older, had a complication, low baseline physical HRQL, or greater baseline physical activity were less likely to be recovered to their preoperative levels of physical activity at 3 weeks. At 2 months, 33% remained below preoperative levels; only high baseline physical activity was an important predictor of prolonged recovery. CONCLUSION: Despite uniformly early discharge, a substantial proportion of patients (∼33%) had suboptimal recovery 2 months after short-stay surgery. Measures of physical activity and HRQOL provide complementary information and reflect the variability in trajectories of recovery after surgery.
BACKGROUND: Although duration of hospital stay commonly is used as a surrogate outcome for surgical recovery, it is not applicable in the setting of short-stay surgery (<24 hours). The objective of our study was to describe the trajectory of recovery after short-stay abdominal surgery by using measures of physical activity and health-related quality of life (HRQL) and identify predictors of prolonged, postdischarge recovery. METHODS:Patients undergoing short-stay abdominal surgery were evaluated preoperatively and at 3 weeks and 2 months postoperatively. Physical activity was assessed with a validated questionnaire (Community Health Activities Model Program for Seniors, ie, CHAMPS) in which patients report physical activity for the previous week; responses estimate total weekly caloric expenditure (kcal/kg/wk). The Medical Outcomes Study 36-Item Short-Form Health survey (SF-36) was used to assess HRQL. Multivariate logistic regression was performed to determine which variables were predictive of recovery to baseline physical activity levels. RESULTS: A total of 132 patients (71% male, 53 [15] years) participated; 91% were discharged on the day of surgery. The most common procedures were open inguinal herniorrhaphy (40%) and laparoscopic cholecystectomy (30%). As a group, total, self-reported physical activity and most domains of HRQL were recovered to or greater than baseline at 3 weeks postoperatively and were above baseline levels at 2 months (P < .01). Patients who were older, had a complication, low baseline physical HRQL, or greater baseline physical activity were less likely to be recovered to their preoperative levels of physical activity at 3 weeks. At 2 months, 33% remained below preoperative levels; only high baseline physical activity was an important predictor of prolonged recovery. CONCLUSION: Despite uniformly early discharge, a substantial proportion of patients (∼33%) had suboptimal recovery 2 months after short-stay surgery. Measures of physical activity and HRQOL provide complementary information and reflect the variability in trajectories of recovery after surgery.
Authors: Nicolò Pecorelli; Julio F Fiore; Chelsia Gillis; Rashami Awasthi; Benjamin Mappin-Kasirer; Petru Niculiseanu; Gerald M Fried; Francesco Carli; Liane S Feldman Journal: Surg Endosc Date: 2015-08-27 Impact factor: 4.584
Authors: Mohsen Alhashemi; Mohammed Almahroos; Julio F Fiore; Pepa Kaneva; Juan Mata Gutierrez; Amy Neville; Melina C Vassiliou; Gerald M Fried; Liane S Feldman Journal: Surg Endosc Date: 2016-09-21 Impact factor: 4.584
Authors: Roshni Alam; Sabrina M Figueiredo; Saba Balvardi; Bénédicte Nauche; Tara Landry; Lawrence Lee; Nancy E Mayo; Liane S Feldman; Julio F Fiore Journal: Surg Endosc Date: 2018-05-17 Impact factor: 4.584
Authors: Julien Maillard; Nadia Elia; Chiara S Haller; Cécile Delhumeau; Bernhard Walder Journal: Health Qual Life Outcomes Date: 2015-02-04 Impact factor: 3.186
Authors: Laleh G Melstrom; Andrei S Rodin; Lorenzo A Rossi; Paul Fu; Yuman Fong; Virginia Sun Journal: J Surg Oncol Date: 2020-09-24 Impact factor: 3.454
Authors: Björn Stessel; Audrey A Fiddelers; Elbert A Joosten; Daisy M N Hoofwijk; Hans-Fritz Gramke; Wolfgang F F A Buhre Journal: Medicine (Baltimore) Date: 2015-09 Impact factor: 1.817