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Conceptual Frameworks of Postoperative Recovery: A Scoping Review

  • Benjamin T. Many
    Correspondence
    Corresponding author. Northwestern University Center for Health Services and Outcomes, 633 East Street, Clair, Chicago, IL 60611-2991. Tel.: +1 312 227 4210; fax: +1 312 227 9678.
    Affiliations
    Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois

    Department of Surgery and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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  • Mohamed Hasan
    Affiliations
    Department of Surgery and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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  • Mehul V. Raval
    Affiliations
    Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois

    Department of Surgery and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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  • Jane L. Holl
    Affiliations
    Department of Neurology, University of Chicago, Chicago, Illinois
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  • Fizan Abdullah
    Affiliations
    Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois

    Department of Surgery and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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  • Hassan Ghomrawi
    Affiliations
    Department of Surgery and Center for Health Services and Outcomes Research, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Published:March 16, 2021DOI:https://doi.org/10.1016/j.jss.2021.01.031

      Abstract

      Objective

      We conducted a scoping review to identify existing conceptual frameworks of postoperative recovery (PR) and assess their content.

      Background

      PR is increasingly recognized by providers and third-party payers as a multidimensional phenomenon. Efforts to optimize PR and reduce complications and readmissions continue to evolve through changes in care (i.e., enhanced recovery protocols) and financial incentives. Delineating all factors affecting PR using a conceptual framework should aid in the design of effective interventions.

      Methods

      Web of Science and PubMed were queried to identify articles, between January 1980 and August of 2019, about conceptual frameworks of PR, using the search terms: “concept,” “model,” “framework,” “recovery after surgery,” “conceptual framework” “postoperative,” “surgery,” and “children.” Articles considering PR as a concept rather than an outcome were included. Articles were examined in accordance with Walker and Avant's method for the concept analysis. Concepts identified across articles were classified as domains and subdomains of PR.

      Results

      The search yielded 183 unique articles; 8 met inclusion/exclusion criteria. Most articles defined PR as a period of days to weeks (n = 7) rather than days (n = 1). PR was mostly conceptualized as a process involving the patient and the health care system (n = 4) rather than the patient alone (n = 2). Physiological recovery (n = 8), activities of daily living (n = 8), pain (n = 5), cognitive/psychological recovery (n = 4), social recovery (n = 2), and patient perspective (n = 1) were the identified domains. Existing patient-reported outcome measures were used to assess most PR domains; however, definitions of domains and subdomains differed. None of the PR conceptual frameworks included were specific to children.

      Conclusions

      There are few conceptual frameworks of PR in adults, and the definitions of PR differ. No framework was specific to children. Consensus on a conceptual framework of PR in adults and development of a conceptual framework of PR specific to children are needed.

      Keywords

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      References

        • Forum N.Q.
        Surgery 2015 - 2017 report.
        in: Services DoHaH. 2017
        • Thiele R.H.
        • Rea K.M.
        • Turrentine F.E.
        • et al.
        Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery.
        J Am Coll Surg. 2015; 220: 430-443
        • Varadhan K.K.
        • Neal K.R.
        • Dejong C.H.C.
        • Fearon K.C.H.
        • Ljungqvist O.
        • Lobo D.N.
        The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective open colorectal surgery: a meta-analysis of randomized controlled trials.
        Clin Nutr. 2010; 29: 434-440
        • Kehlet H.
        • Wilmore D.W.
        Multimodal strategies to improve surgical outcome.
        Am J Surg. 2002; 183: 630-641
        • Lee L.
        • Tran T.
        • Mayo N.E.
        • Carli F.
        • Feldman L.S.
        What does it really mean to "recover" from an operation?.
        Surgery. 2014; 155: 211-216
        • Hines A.L.
        • Barrett M.L.
        • Jiang H.J.
        • Steiner C.A.
        Conditions with the Largest Number of Adult Hospital Readmissions by Payer, 2011: Statistical Brief #172. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs.
        Agency for Healthcare Research and Quality (US), Rockville, MD2006
        • Ljungqvist O.
        • Scott M.
        • Fearon K.C.
        Enhanced recovery after surgery: a review.
        JAMA Surg. 2017; 152: 292-298
        • Micic D.
        • Gaetano J.N.
        • Rubin J.N.
        • et al.
        Factors associated with readmission to the hospital within 30 days in patients with inflammatory bowel disease.
        PLoS One. 2017; 12: e0182900
        • Borza T.
        • Oerline M.K.
        • Skolarus T.A.
        • et al.
        Association between hospital participation in medicare shared savings program accountable care organizations and readmission following major surgery.
        Ann Surg. 2019; 269: 873-878
        • Sibia U.S.
        • Turcotte J.J.
        • Klune J.R.
        • Gibson G.R.
        Are we ready for bundled payments for major bowel surgery?.
        Surg Endosc. 2019; 34: 4950-4956
        • Chandra A.
        • Dalton M.A.
        • Holmes J.
        Large increases in spending on postacute care in Medicare point to the potential for cost savings in these settings.
        Health Aff (Millwood). 2013; 32: 864-872
        • Miller D.C.
        • Gust C.
        • Dimick J.B.
        • Birkmeyer N.
        • Skinner J.
        • Birkmeyer J.D.
        Large variations in Medicare payments for surgery highlight savings potential from bundled payment programs.
        Health Aff (Millwood). 2011; 30: 2107-2115
        • Shinnick J.K.
        • Short H.L.
        • Heiss K.F.
        • Santore M.T.
        • Blakely M.L.
        • Raval M.V.
        Enhancing recovery in pediatric surgery: a review of the literature.
        J Surg Res. 2016; 202: 165-176
        • Tan M.
        • Law L.S.
        • Gan T.J.
        Optimizing pain management to facilitate enhanced recovery after surgery pathways.
        Can J Anaesth. 2015; 62: 203-218
        • Mori M.
        • Angraal S.
        • Chaudhry Sarwat I.
        • et al.
        Characterizing patient-centered postoperative recovery after adult cardiac surgery: a systematic review.
        J Am Heart Assoc. 2019; 8: e013546
        • Kash B.A.
        • Zhang Y.
        • Cline K.M.
        • Menser T.
        • Miller T.R.
        The perioperative surgical home (PSH): a comprehensive review of US and non-US studies shows predominantly positive quality and cost outcomes.
        Milbank Q. 2014; 92: 796-821
        • Sodhi C.
        • Richardson W.
        • Gribar S.
        • Hackam D.J.
        The development of animal models for the study of necrotizing enterocolitis.
        Dis Model Mech. 2008; 1: 94-98
        • Reason & Rigor
        How Conceptual Frameworks Guide Research.
        Reference & Research Book News, Thousand Oaks, CA2012
        • Jabareen Y.
        Building a conceptual framework: philosophy, definitions, and procedure.
        Int J Qual Methods. 2009; 8: 49-62
        • Ljungqvist O.
        • Scott M.
        • Fearon K.C.
        Enhanced recovery after surgery: a review enhanced recovery after surgery enhanced recovery after surgery.
        JAMA Surg. 2017; 152: 292-298
        • Bowyer A.
        • Royse C.
        The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications.
        Can J Anaesth. 2016; 63: 176-183
        • Greco M.
        • Capretti G.
        • Beretta L.
        • Gemma M.
        • Pecorelli N.
        • Braga M.
        Enhanced recovery program in colorectal surgery: a meta-analysis of randomized controlled trials.
        World J Surg. 2014; 38: 1531-1541
        • Kain Z.N.
        • Vakharia S.
        • Garson L.
        • et al.
        The perioperative surgical home as a Future perioperative practice model.
        Anesth Analgesia. 2014; 118: 1126-1130
        • Cunningham D.
        • Karas V.
        • DeOrio J.K.
        • Nunley J.A.
        • Easley M.E.
        • Adams S.B.
        Possible implications for bundled payment models of comorbidities and complications as drivers of cost in total ankle arthroplasty.
        Foot Ankle Int. 2019; 40: 210-217
        • Cromwell J.
        • Dayhoff D.A.
        • Thoumaian A.H.
        Cost savings and physician responses to global bundled payments for Medicare heart bypass surgery.
        Health Care Financ Rev. 1997; 19: 41-57
        • Arksey H.
        • O'Malley L.
        Scoping studies: towards a methodological framework.
        Int J Soc Res Methodol. 2005; 8: 19-32
        • Streeton R.
        • Cooke M.
        • Campbell J.
        Researching the researchers: using a snowballing technique.
        Nurse Res. 2004; 12: 35-47
        • Sweeney A.
        • Greenwood K.E.
        • Williams S.
        • Wykes T.
        • Rose D.S.
        Hearing the voices of service user researchers in collaborative qualitative data analysis: the case for multiple coding.
        Health Expect. 2013; 16: e89-e99
        • Carli F.
        • Mayo N.
        Measuring the outcome of surgical procedures: what are the challenges?.
        Br J Anaesth. 2001; 87: 531-533
        • Allvin R.
        • Berg K.
        • Idvall E.
        • Nilsson U.
        Postoperative recovery: a concept analysis.
        J Adv Nurs. 2007; 57: 552-558
        • Royse C.F.
        • Newman S.
        • Chung F.
        • et al.
        Development and feasibility of a scale to assess postoperative recovery: the post-operative quality recovery scale.
        Anesthesiology. 2010; 113: 892-905
        • Stark P.A.
        • Myles P.S.
        • Burke J.A.
        Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15.
        Anesthesiology. 2013; 118: 1332-1340
        • Lee L.
        • Dumitra T.
        • Fiore Jr., J.F.
        • Mayo N.E.
        • Feldman L.S.
        How well are we measuring postoperative “recovery” after abdominal surgery?.
        Qual Life Res. 2015; 24: 2583-2590
        • Bowyer A.J.
        • Royse C.F.
        Postoperative recovery and outcomes–what are we measuring and for whom?.
        Anaesthesia. 2016; 71: 72-77
        • Alam R.
        • Figueiredo S.M.
        • Balvardi S.
        • et al.
        Development of a patient-reported outcome measure of recovery after abdominal surgery: a hypothesized conceptual framework.
        Surg Endosc. 2018; 32: 4874-4885
        • Alam R.
        • Montanez J.
        • Law S.
        • et al.
        Development of a conceptual framework of recovery after abdominal surgery.
        Surg Endosc. 2019; 34: 2665-2674
        • Patel A.R.
        • Sarkisova N.
        • Smith R.
        • Gupta K.
        • VandenBerg C.D.
        Socioeconomic status impacts outcomes following pediatric anterior cruciate ligament reconstruction.
        Medicine. 2019; 98: e15361
        • Agabiti N.
        • Cesaroni G.
        • Picciotto S.
        • et al.
        The association of socioeconomic disadvantage with postoperative complications after major elective cardiovascular surgery.
        J Epidemiol Community Health. 2008; 62: 882-889
        • Hall M.J.
        • Schwartzman A.
        • Zhang J.
        • Liu X.
        Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010.
        Natl Health Stat Rep. 2017; : 1-15
        • Tzong K.Y.
        • Han S.
        • Roh A.
        • Ing C.
        Epidemiology of pediatric surgical admissions in US children: data from the HCUP kids inpatient database.
        J Neurosurg Anesthesiol. 2012; 24: 391-395
        • Rabbitts J.A.
        • Groenewald C.B.
        • Moriarty J.P.
        • Flick R.
        Epidemiology of ambulatory anesthesia for children in the United States: 2006 and 1996.
        Anesth Analgesia. 2010; 111: 1011-1015
        • Baraldi E.
        • Cooper D.M.
        • Zanconato S.
        • Armon Y.
        Heart rate recovery from 1 minute of exercise in children and adults.
        Pediatr Res. 1991; 29: 575-579
        • Scott R.
        “It hurts red:” A preliminary study of children's perception of pain.
        Perceptual Mot Skills. 1978; 47: 787-791
        • Piaget J.
        Piaget’s theory.
        in: Inhelder B. Chipman H.H. Zwingmann C. Piaget and His School: A Reader in Developmental Psychology. Springer Berlin Heidelberg, Berlin, Heidelberg1976: 11-23
        • Heine S.J.
        • Lehman D.R.
        • Markus H.R.
        • Kitayama S.
        Is there a universal need for positive self-regard?.
        Psychol Rev. 1999; 106: 766-794