Short-stay surgery: what really happens after discharge?

BACKGROUND: Although duration of hospital stay commonly is 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 by using measures of physical activity and health-related quality of life (HRQL) and identify predictors of prolonged, postdischarge recovery.

METHODS: Patients undergoing short-stay abdominal surgery were evaluated preoperatively and at 3 weeks and 2 months postoperatively. Physical activity was assessed with a validated questionnaire (Community Health Activities Model Program for Seniors, ie, CHAMPS) in which patients report physical activity for the previous week; responses estimate total weekly caloric expenditure (kcal/kg/wk). The Medical Outcomes Study 36-Item Short-Form Health survey (SF-36) was used to assess HRQL. Multivariate logistic regression was performed to determine which variables were predictive of recovery to baseline physical activity levels.

RESULTS: A total of 132 patients (71% male, 53 [15] years) participated; 91% were discharged on the day of surgery. The most common procedures were open inguinal herniorrhaphy (40%) and laparoscopic cholecystectomy (30%). As a group, total, self-reported physical activity and most domains of HRQL were recovered to or greater than baseline at 3 weeks postoperatively and were above baseline levels at 2 months (P < .01). Patients who were older, had a complication, low baseline physical HRQL, or greater baseline physical activity were less likely to be recovered to their preoperative levels of physical activity at 3 weeks. At 2 months, 33% remained below preoperative levels; only high baseline physical activity was an important predictor of prolonged recovery.

CONCLUSION: Despite uniformly early discharge, a substantial proportion of patients (∼33%) had suboptimal recovery 2 months after short-stay surgery. Measures of physical activity and HRQOL provide complementary information and reflect the variability in trajectories of recovery after surgery.