Short-stay Surgery: What Really Happens After Discharge?

Introduction: Innovations in surgery and perioperative care enable rapid hospital discharge after a variety of procedures. While length of hospital stay is commonly 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 using measures of physical activity and quality of life.

Methods: Patients scheduled for short-stay abdominal surgery at a University Medical Centre were evaluated preoperatively, 3 weeks and 2 months postoperatively. Physical activity was assessed using the 41-item Community Health Activities Model Program for Seniors [CHAMPS] questionnaire where patients report physical activity over a range of intensities for the previous week; responses are converted into caloric expenditure (kcal/kg/wk). The Medical Outcomes Study 36-Item Short-Form Health survey (SF-36) was used to assess health-related quality of life. Data are expressed as median and interquartile range. P<0.05 was considered statistically significant.

Results: 135 patients, 71% male with a mean (SD) age of 53 (15) years participated. 91% were ambulatory, while 9 % were discharged the morning after surgery. The three most common ambulatory procedures were open inguinal hernia repair (38%), laparoscopic cholecystectomy (30%) and umbilical hernia repair (9%). Short-stay procedures included laparoscopic splenectomy, adrenalectomy and Heller myotomy. CHAMPS-estimated energy expenditure returned to baseline from 30[18-58] preop to 30[15-50] 3 weeks postop, and increased above baseline levels to 44[26-74] at 2 months (P<.001 vs baseline). At 3 weeks, 48% were at or above baseline while 52% remained below baseline. At 2 months, 33% remained below baseline. The physical function, vitality, pain and general health subscales of the SF-36 and physical activity as measured by CHAMPS had low to moderate correlation (r= 0.16-0.54) with each other at most postoperative time points.

Conclusion: Despite uniformly early discharge, a significant proportion of patients had suboptimal recovery two months after short-stay surgery. Measures of physical activity and health-related quality of life provide complementary information and better reflect the variability in trajectories of recovery after surgery.

Session: Podium Presentation

Program Number: S069

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