title: Short-stay surgery: what really happens after discharge?
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, McGill University, Montreal, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Canada.
authors.forename: Tung T
authors.initials: TT
authors.lastname: Tran
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Canada.
authors.forename: Pepa
authors.initials: P
authors.lastname: Kaneva
authors.affiliation: Division of Clinical Epidemiology, McGill University, Montreal, Canada; School of Physical and Occupational Therapy, McGill University, Montreal, Canada.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Mayo
authors.affiliation: Department of Surgery, McGill University, Montreal, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Canada.
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.affiliation: Department of Surgery, McGill University, Montreal, Canada; Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal, Canada. Electronic address: liane.feldman@mcgill.ca.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D005500:Follow-Up Studies; D059685:Herniorrhaphy; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge; D011184:Postoperative Period; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D055815:Young Adult