The meaning of recovery goes beyond traditional clinical parameters
Montreal, ─ “How long will it take before I recover?” is the basic question patients ask when they learn they need abdominal surgery. The answer should take into consideration patients’ perspectives on recovery, argue a team of researchers at the Research Institute of the McGill University Health Centre (RI-MUHC) in a recent study published online in JAMA Surgery. Their findings support that to patients, the meaning of recovery goes beyond traditional clinical parameters commonly assessed in surgical research and include an interplay of physical, psychological and social factors that should be addressed in surgeon-patient discussions about recovery.
Abdominal surgery-including resection of abdominal cancer, appendix removal, gallbladder removal and hernia repairs-is the most common type of inpatient surgical procedure conducted in North America. Nevertheless, postoperative recovery remains difficult to define or measure as all the stakeholders involved in surgery, including patients, surgeons, nurses, hospital administrators and policymakers, may have different standpoints.
“Given that the impact of abdominal surgery is primarily experienced by patients, understanding what recovery means to them is essential, and this is what we aimed to do in this study,” says Dr. Julio F. Fiore Junior, a scientist in the Injury Recovery Program at the RI-MUHC and principal investigator in this study.
In this international study, 30 patients were interviewed after undergoing different abdominal surgery procedures in four different countries (Canada, Italy, Brazil and Japan). They answered open-ended questions such as: Do you feel that you are completely recovered? When will you consider yourself to be completely recovered? Other questions related to challenges and difficulties faced during their recovery process. A qualitative thematic analysis was conducted and recurring themes reflecting the meaning of recovery were identified.
Back to normal life
Respondents attributed postoperative recovery to returning to previous habits and routines, resolving symptoms and mental strains caused by surgery, regaining independence in daily tasks and enjoying life.
“Studies addressing strategies aimed to improve recovery, such as minimally invasive surgery and surgical care pathways, commonly focus on the duration of hospital stay, complication rates, or biological/physiological variables. Although these parameters are relevant to clinicians and other healthcare stakeholders, they do not reflect the complexity of the recovery process or fully capture the perspective of patients,” says Dr. Fiore, who also is an Assistant Professor (Research), in the Department of Surgery at McGill University.
“We were able to develop a clear picture of what matters to patients,” says the first author of the study, Dr. Fateme Rajabiyazdi, who was a postdoctoral fellow at the time of the study. “For example, we found that resuming everyday life preoperative activities, like working, exercising or caring for children or grandchildren was an important part of being recovered.”
Not feeling pain, regaining appetite and overcoming digestive issues were other indicators of recovery mentioned in the study. As well, overcoming worries about whether the pain would ever go away and long-term surgical outcomes was another important aspect of recovery, just like being able to smile, dance and have fun again. Finally, being able to complete everyday tasks without assistance, like getting out of bed, getting dressed and eventually driving, were also important components of being “fully recovered”.
“Patient centeredness is an essential component of high-quality healthcare, and recent literature has advocated that postoperative recovery be measured using patient-reported outcome measures,” says Dr. Liane Feldman, co-principal investigator of the study, Surgeon-in-Chief and Medical Director of the Surgical Mission of the MUHC and Chair of the Department of Surgery at McGill Faculty of Medicine and Health Sciences. “Our findings should therefore inform the development of patient-centred strategies to measure and improve postoperative outcomes.”
About the study
The study Understanding the Meaning of Recovery to Patients Undergoing Abdominal Surgery was conducted by Fateme Rajabiyazdi; Roshni Alam; Aditya Pal; Joel Montanez; Susan Law;Nicolò Pecorelli; YusukeWatanabe; Luciana D. Chiavegato; Massimo Falconi; Satoshi Hirano; Nancy E.Mayo; Lawrence Lee; Liane S. Feldman and Julio F. Fiore Jr
About the RI-MUHC
The Research Institute of the McGill University Health Centre (RI-MUHC) is a world-renowned biomedical and healthcare research centre. The institute, which is affiliated with the Faculty of Medicine of McGill University, is the research arm of the McGill University Health Centre (MUHC)-an academic health centre located in Montreal, Canada, that has a mandate to focus on complex care within its community. The RI-MUHC supports over 450 researchers and around 1,200 research trainees devoted to a broad spectrum of fundamental, clinical and health outcomes research at the Glen and the Montreal General Hospital sites of the MUHC. Its research facilities offer a dynamic multidisciplinary environment that fosters collaboration and leverages discovery aimed at improving the health of individual patients across their lifespan. The RI-MUHC is supported in part by the Fonds de recherche du Québec – Santé (FRQS). rimuhc.ca
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