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Development of a conceptual framework of recovery after abdominal surgery

  • 2019 SAGES Oral
  • Published:
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ABSTRACT

Background

There is a lack of patient-reported outcome measures (PROMs) with robust measurement properties to assess postoperative recovery and support patient-centered care after abdominal surgery. The aim of this study was to establish a conceptual framework of recovery after abdominal surgery to support the development of a conceptually relevant and psychometrically sound PROM.

Methods

Patients from four different countries (Canada, Italy, Brazil, and Japan) participated in qualitative interviews focusing on their lived experiences of recovery after abdominal surgery. Interviews were guided by a previously developed hypothesized conceptual framework established based on a literature review and expert consensus. Interviews were analyzed according to a modified grounded theory approach and transcripts were coded according to the International Classification of Functioning, Disability and Health (ICF). Codes for which thematic saturation was reached were classified into domains of health that are relevant to the process of recovery after abdominal surgery. These domains were organized into a structured diagram.

Results

30 Patients with diverse demographics and surgical characteristics were interviewed (50% female, age 57 ± 18 years, 66% major or major extended surgery). 39 Unique domains of recovery emerged from the interviews, 17 falling under the ICF category of “Body Functions” and 22 under “Activities and Participation”. These domains constitute the conceptual framework of recovery after abdominal surgery.

Conclusions

This study provides comprehensive insight into patients’ perspectives of the recovery process after abdominal surgery. This conceptual framework will support content validity and provide the pivotal basis for the development of a novel PROM to inform quality improvement initiatives and patient-centered research in abdominal surgery.

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Adaption of figure reprinted by permission from Springer Nature. License #: 4543180324229, Alam et al. [15]

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Acknowledgements

We extend our gratitude to the patients, perioperative experts, and researchers that participated in our Advisory Panel meetings and provided their invaluable input throughout the study. We would also like to thank Pepa Kaneva without whom the coordination of this project would not be possible. Thanks to Daria Manzotti for assisting in the completion of Italian interviews and Dr. Silvia Cicala for revising all of the Italian interview transcripts. Lastly, thanks to Andreas Enzenhöfer for taking the time to assist with Canadian interviews.

Funding

This work was supported by a SAGES Surgical Multimodal Accelerated Recovery Trajectory (SMART) Grant and a Merck Investigator-Initiated Study Grant (IIS Number VT 57203). The Steinberg-Bernstein Centre for Minimally Invasive Surgery (McGill University Health Centre, Montreal, Canada) is supported in part by an Unrestricted Education Grant from Medtronic.

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Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Roshni Alam, Lawrence Lee, Liane S. Feldman & Julio Flavio Fiore Jr.

  2. Department of Surgery, McGill University Health Centre, Montreal General Hospital, McGill University, 1650 Cedar Ave, L8-121, Montreal, QC, H3G 1A4, Canada

    Roshni Alam, Lawrence Lee, Liane S. Feldman & Julio Flavio Fiore Jr.

  3. St. Mary’s Research Centre, St. Mary’s Hospital, Montreal, QC, Canada

    Joel Montanez

  4. Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada

    Susan Law

  5. Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Susan Law

  6. Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy

    Nicolò Pecorelli & Massimo Falconi

  7. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Yusuke Watanabe & Satoshi Hirano

  8. Department of Medicine, Pulmonary Division, Federal University of São Paulo, São Paulo, Brazil

    Luciana D. Chiavegato

  9. School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada

    Nancy E. Mayo

  10. Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada

    Nancy E. Mayo

  11. Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada

    Nancy E. Mayo, Liane S. Feldman & Julio Flavio Fiore Jr.

Authors
  1. Roshni Alam
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  2. Joel Montanez
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  3. Susan Law
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  4. Lawrence Lee
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  6. Yusuke Watanabe
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  7. Luciana D. Chiavegato
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  8. Massimo Falconi
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  9. Satoshi Hirano
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  10. Nancy E. Mayo
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  11. Liane S. Feldman
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  12. Julio Flavio Fiore Jr.
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Corresponding author

Correspondence to Julio Flavio Fiore Jr..

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Disclosures

Julio F. Fiore reports a Grant from SAGES and Merck Canada Inc. during the conduct of this study. Liane S. Feldman reports a Grant from SAGES during the conduct of this study, and a Grant from Medtronic outside the submitted work. Lawrence Lee reports Grants from Johnson and Johnson outside the submitted work. Yusuke Watanabe reports Personal Fees from Johnson and Johnson, Medtronic, Olympus, AMCO Incorporated, and Sakura Seiki Co. Ltd., outside the submitted work. Roshni Alam, Joel Montanez, Susan Law, Nancy E. Mayo, Nicolò Pecorelli, Luciana D. Chiavegato, Massimo Falconi, and Satoshi Hirano have no conflicts of interest or financial ties to disclose.

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Presented at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Annual Meeting in Baltimore, Maryland, United States, April 6, 2019.

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Alam, R., Montanez, J., Law, S. et al. Development of a conceptual framework of recovery after abdominal surgery. Surg Endosc 34, 2665–2674 (2020). https://doi.org/10.1007/s00464-019-07044-x

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