A CONCEPTUAL FRAMEWORK OF RECOVERY AFTER ABDOMINAL SURGERY

Roshni Alam^1,2, Joel Montanez³, Susan Law³, Lawrence Lee^1,2, Nicolò Pecorelli⁴, Yusuke Watanabe⁵, Chiavegato D Luciana⁶, Massimo Falconi⁴, Hirano Satoshi⁵, Nancy E Mayo^7,8,9, Liane S Feldman^1,2,9, Julio F Fiore Jr^1,2,9. ¹Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada, ²Department of Surgery, McGill University Health Centre, Montreal, QC, Canada, ³St. Mary’s Research Centre, St. Mary’s Hospital, Montreal, QC, Canada, ⁴Division of Pancreatic Surgery, Pancreas Translational & Clinical Research Centre, San Raffaele Scientific Institute, Milan, Italy, ⁵Department of Gastrointestinal Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan, ⁶Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil, ⁷School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada, ⁸Division of Clinical Epidemiology, McGill University, Montreal, QC, Canada, ⁹Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada

INTRODUCTION: There is a lack of patient-reported outcome measures (PROMs) with robust measurement properties to assess postoperative recovery and support value-based patient-centered care. To bridge this knowledge gap, we initiated a research program to develop a conceptually relevant and psychometrically sound recovery-specific PROM. In compliance with recommendations for PROM development, in the first stage of this program we developed a conceptual framework representing the domains relevant to the process of recovery after abdominal surgery.

METHODS AND PROCEDURES: Abdominal surgery patients from 4 international sites (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 by literature review and expert consensus. Interviews were analyzed according to a modified grounded theory approach and transcripts were coded according to health domains covered by 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: 20 patients with diverse demographics and surgical characteristics were interviewed (40% male, age 53±19 years, 70% major or major extended surgery). 35 unique domains of recovery emerged from the interviews, all falling under the ICF categories of "Body Functions" and "Activities and Participation".

CONCLUSION: The results from this study provide comprehensive insight into the process of recovery from the patients’ perspective. The conceptual framework of recovery after abdominal surgery will support content validity and underpin the generation of items for the future recovery-specific PROM. This framework is also a pivotal first step leading to a novel measure to be used in research informing patient-centered decision-making as well as quality improvement initiatives in abdominal surgery.