Up to 1 in 4 patients report more physical problems a year after surgery than before

One in seven patients experience more pain, physical and emotional problems a year after surgery than before their operation and a quarter have less vitality. Those are the key findings of a research study of more than 400 patients published online by the British Journal of Surgery.

Researchers from The Netherlands spoke to 216 women and 185 men with an average age of 54, who had undergone planned surgery, ranging from plastic surgery to orthopaedic surgery.

They used the SF-36 health survey to measure pain, physical functioning, mental health and vitality before surgery and six and 12 months after each patient's operation. The researchers also asked patients how far they had moved towards a 100% recovery, six and 12 months after surgery.

"Our study showed poor recovery was relatively frequent six and 12 months after surgery and could be partly explained by various physical and psychological factors" says Dr Madelon Peters from the Department of Clinical Psychological Science at Maastricht University. "These included acute postoperative pain and presurgical anxiety."

Key findings included:

• More than half of the patients (53%) said that their pain levels had improved 12 months after their operation and 29% said they were stable, but 17% reported greater pain.

• Most patients had better (43%) or similar (43%) functional abilities at 12 months, but 14% said their functional abilities had reduced.

• At 12 months, 34% of patients had better mental health, 50% did not change and 16% had poorer mental health.

• Vitality increased in 39% of patients, remained the same in 37% and fell in 24% at 12 months.

• When it came to overall recovery, patients reported that their average level of recovery was 79% at six months and 82% at 12 months. Only 47% of patients had achieved near optimal recovery - defined as 90% or more - at 12 months, with 15% perceiving their recovery at 50% or less.

"Our research found that 15% of patients were still reporting pain and physical and emotional problems a year after surgery and 24% felt they had less vitality than before their operation" says Dr Peters.

"The strongest predictor of pain intensity at follow-up was the level of pain in the first four days after the patient's operation. Higher levels of acute postoperative pain were also associated with poorer long-term physical functioning and overall perceived recovery.

"We also found a significant association between patients who were worried before their operation about the consequences of surgery and lower than average improvements in physical functioning and vitality at follow-up.

"Most of the changes in health-related quality of life occurred during the first six months after surgery, after which the patients' conditions appeared to remain stable.

"It is clearly important to monitor how patients recover during this period as an initially poor recovery may have lasting consequences."

To view the article free visit: http://onlinelibrary.wiley.com/doi/10.1002/bjs.7152/pdf

There is also a free podcast, featuring lead author Dr Madelon Peters, at: http://www.bjs.co.uk/view/0/podcasts.html

Predictors of physical and emotional recovery 6 and 12 months after surgery. Peters et al. British Journal of Surgery. Published online in advance of hard copy publication. (August 2010). DOI: 10.1002/bjs.7152. The article can be viewed free online at: http://onlinelibrary.wiley.com/doi/10.1002/bjs.7152/pdf and the accompanying podcast is at: http://www.bjs.co.uk/view/0/podcasts.html

BJS is the premier peer-reviewed surgical journal in Europe and one of the top surgical periodicals in the world, with an impact factor of 4.921. Its international readership is reflected in its prestigious international Editorial Board, supported by a panel of over 1200 reviewers worldwide. BJS features the very best in clinical and laboratory-based research on all aspects of general surgery and related topics and has a tradition of publishing high quality papers in breast, upper GI, lower GI, vascular, endocrine and surgical sciences. Papers include leading articles, reviews and original research articles, correspondence and book reviews. http://www.bjs.co.uk

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