title: Predictors of physical and emotional recovery 6 and 12 months after surgery.
abstract: BACKGROUND
  A proportion of patients do not recover fully from surgery or they develop chronic postsurgical pain. The aim of this study was to examine the incidence and predictors of unfavourable long-term outcome after surgery using a prospective cohort design.
  
  
  METHODS
  Some 401 patients undergoing various elective surgical procedures filled in the RAND 36-item Health Survey 1.0 health-related quality-of-life questionnaire before operation and at 6 and 12 months of follow-up to assess changes in pain, physical functioning, mental health and vitality. Preoperative psychological assessment was obtained.
  
  
  RESULTS
  Most patients showed improvement in the various aspects of health-related quality of life after surgery, but a considerable proportion (14-24 per cent) still showed deterioration at 6 and 12 months. Multivariable linear regression analysis identified acute postoperative pain, duration of the operation and preoperative physical condition as the most important predictors of long-term pain and physical functioning. Preoperative surgical fear also had a small but significant contribution. The main predictors of mental health and vitality were physical condition before surgery, surgical fear and optimism.
  
  
  CONCLUSIONS
  Up to a quarter of patients experienced suboptimal recovery after surgery. Both somatic and psychological factors were associated with the long-term outcome. Optimal recovery could be promoted by effective interventions on malleable factors.
authors.affiliation: Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands. Madelon.Peters@maastrichtuniversity.nl
authors.forename: M L
authors.initials: ML
authors.lastname: Peters
authors.forename: M
authors.initials: M
authors.lastname: Sommer
authors.forename: M
authors.initials: M
authors.lastname: van Kleef
authors.forename: M A E
authors.initials: MA
authors.lastname: Marcus
mesh_terms: D000203:Activities of Daily Living; D000342:Affective Symptoms / Q000209:etiology*; D001007:Anxiety / Q000209:etiology; D017558:Elective Surgical Procedures / Q000523:psychology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010149:Postoperative Pain / Q000523:psychology*; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D012044:Regression Analysis