Understanding the Meaning of Recovery to Patients Undergoing Abdominal Surgery

Abstract

Importance: Postoperative recovery is difficult to define or measure. Research addressing interventions aimed to improve recovery after abdominal surgery often focuses on measures such as duration of hospital stay and complication rates. Although these clinical parameters are relevant, understanding patients' perspectives regarding postoperative recovery is fundamental to guiding patient-centered care.

Objective: To elucidate the meaning of recovery from the perspective of patients undergoing abdominal surgery.

Design, setting, and participants: This international qualitative study involved semistructured interviews with patients recovering from abdominal surgery from October 2016 to November 2018 in tertiary hospitals in 4 countries (Canada, Italy, Brazil, and Japan). A purposive maximal variation sampling method was used to ensure the recruitment of patients with varying demographic, clinical, and surgical characteristics. Data on race were not collected. Each interview lasted between 1 and 2 hours. Interviews were recorded and then transcribed verbatim. Transcripts were then analyzed using an inductive thematic analysis approach. Data analysis was conducted from July 2019 to September 2019.

Main outcomes and measures: The qualitative analysis revealed themes reflecting the meaning of recovery from the perspective of patients undergoing abdominal surgery.

Results: Thirty patients recovering from abdominal surgery were interviewed (15 [50%] female; mean [SD] age, 57 [18] years; 10 [33%] underwent major surgery; 16 [53%] underwent laparoscopic surgery). The interviews revealed that for patients undergoing abdominal surgery, the meaning of recovery embodied 5 overarching themes: (1) returning to habits and routines, (2) resolution of symptoms, (3) overcoming mental strains, (4) regaining independence, and (5) enjoying life. Themes associating the meaning of recovery to traditional parameters, such as earlier hospital discharge or absence of complications, were not identified in the interviews.

Conclusions and relevance: This qualitative study suggests that the meaning of recovery from the perspective of patients undergoing abdominal surgery goes beyond traditional clinical parameters. The elements of recovery identified in this study should be taken into account in patient-surgeon discussions about recovery and when developing patient-centered strategies to improve postoperative outcomes.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Rajabiyazdi reports grants from Merck Canada and was supported by studentships offered by Mitacs Canada during the conduct of the study. Dr Alam reports grants from Mitacs Canada during the conduct of the study. Dr Watanabe reports personal fees from Covidien Japan, Johnson & Johnson, AMCO, and Olympus and consulting from Iwasaki Industry outside the submitted work. Dr Lee reports grants from Johnson & Johnson outside the submitted work. Dr Fiore reports grants from Merck Canada during the conduct of the study. No other disclosures were reported.

Figures

Figure.. Themes and Subthemes Concerning the Meaning of Recovery After Abdominal Surgery