Postoperative recovery and outcomes – what are we measuring and for whom?

Abstract

SummaryRecovery is an abstract quantity the definition of which varies according to the pre-dilection of individual institutions, clinicians or patients. While traditionally focused on immediate postoperative restitution of function and readiness for discharge, recovery assessment has progressively expanded its focus to include other clinically relevant time periods, each of which is influenced by specific factors. Assessment tools have progressed from assessing one dimension of recovery, such as physiological variables, to multidimensional assessment of physical, nociceptive, emotive, functional and cognitive performance. They should be validated ideally for repeat measures and should provide realtime recovery data, as recovery can be viewed as a continuous process. Recovery time periods -relevance, influences and focus Postoperative recovery is complete when function is restored and adverse symptoms have resolved. Function and symptoms can be assessed at time points considered significant by the patient, clinician or institution.The outcomes of the 'enhanced recovery after surgery' pathways were initially determined by clinicians rather than patients, and emphasised what happened in hospital -length of hospital stay, complications and early organ dysfunction [1]. However, reductions in length of hospital stay and complications associated with the enhanced recovery pathway are of limited interest to patients [2,3]. Patients rarely achieve normal levels of function and are usually symptomatic on discharge after major surgery, the timing of which is influenced by organisational factors and correlates poorly with longer term recovery [1,2].Postoperative enhanced recovery, as a process and as an endpoint, is now assessed during three stages: from the end of surgery to discharge from the postanaesthetic care unit; from then until hospital discharge; and, finally, until normal function has been restored. Simple physiological variables predominantly influence the first stage. The second and third stages are predominantly influenced by pain, more complex physiology and function.Tools generated by clinicians from various specialties, rather than just surgery, also define recovery over three phases, their cumulative duration exceeding 72

Association of pain ratings with the prediction of early physical recovery after general and orthopaedic surgery—A quantitative study with repeated measures

“…() in an initial validation study of the PRP instrument. A second reason for the reduction was that the physical dimensions are described to have the greatest significance during the first days after surgery (Bowyer & Royse, ). Data were collected at six different wards to strengthen external validity.…”

“…By tradition, postoperative recovery refers to the phase during which patients stay in the care units. This phase of recovery is described as regaining control of function to enable discharge (Bowyer & Royse, ). Pain is the most common item in recovery assessment tools (Allvin et al., ; Feldman et al., ; Neville et al., ).…”

Predictive Factors Affecting Postoperative Quality of Recovery for Patients Undergoing Surgery

“…Understanding factors affecting post-operative recovery is of great importance of efforts to reduce morbidity and mortality after surgery. This study was conducted to assess the predictive factors affecting postoperative quality of recovery for patients undergoing surgery [4].…”

“…Recovery may also be viewed as absolute or relative. Therefore, it is not necessarily obvious whether a patient has 'recovered' from their operation as the definition of 'recovered' can vary [4]. The recovery process therefore extends from the end of the anaesthetic and can continue over a period of several months after discharge, and occasionally not even returning to preoperative baseline.…”

Understanding patients’ experiences of recovery after staged complex aortic repair: A phenomenological study

“…The World Health Organisation defines health as a state of complete physical, mental, and social well‐being and not merely the absence of disease or infirmity (World Health Organization, ). The complex and continuous postoperative recovery process, affecting respective patients differently on emotional, social and physical levels over time, needs to be acknowledged (Bowyer & Royse, ). Patients with complex aortic diseases may have gone from being an asymptomatic and independent person to facing a life‐threatening diagnosis and multiple risky operations.…”