“Will it really take a whole year to recover from my surgery? My surgeon didn't mention anything about that. I was hoping to be back on the pickleball/tennis/basketball court in just a few weeks.”
Yes, you read that correctly - surgical recovery can indeed be a lengthy process. In the time it may take to completely recover, you could practically build a new house. Or make significant progress in learning a new language.
During discussions about the surgical procedure, potential complications, and all the necessary pre-op appointments like bloodwork and CT scans, the topic of a prolonged recovery might not come up.
Commonly patients inquire about timelines for specific activities - “Doc, how long until I can [blank].’’ And then we give a ballpark estimate or offer a vague answer such as “Well … it depends on a bunch of stuff, really.”
Not surprisingly, then, the idea of taking an entire year to recover can come as a surprise to most patients, and even physicians may not anticipate such an extended recovery period.
But before we go any further, let's first clarify what I mean by ‘surgical recovery.'
Defining Postoperative Recovery
After the initial few weeks or months, most surgeons will deem you as recovered. Your wounds will have healed, your bowels will be functioning, and you'll be back on your feet. During this period, you'll receive guidelines regarding physical activity limitations, when it's safe to resume bathing, and when you can return to work. This phase is commonly referred to as short-term recovery, typically spanning 4 to 6 weeks.
However, it's important to distinguish between in-hospital recovery (reaching a stage suitable for discharge), short-term recovery, and the broader concept of long-term recovery. This encompasses such aspects as regaining your pre-surgery level of activity, energy, strength and overall quality of life.
In a 2020 paper that presents a conceptual framework of recovery, Alam and colleagues show how surgery directly impacts several different domains of a patient’s health, which should all be taken into account when measuring recovery.
They classified 39 unique domains of recovery into “Body Functions” and “Activities and Participation.” Here is a sample from each:
Body functions
Sensation of pain
Energy and drive
Muscle power
Sleep function
Digestive function
Activities and participation
Dressing
Recreation and leisure
Doing housework
Employment
Washing oneself
Driving
Preparing meals
Intimate relationships
We are going to refer to these domains as your functional ability – your ability to carry on normal activities of life and daily living.
Then, after surgery, your functional or physical recovery refers to your capacity to carry out meaningful daily activities and, most importantly, maintain your ability to live independently.
In this article, we will first review the course of long-term physical recovery following surgery. Then, in part two, we will suggest a new method you can use to speed up the whole process.
To maintain our focus, this article will not discuss the following:
complications or death after surgery
cognitive or psychological recovery
physiological recovery (such as bowel and kidney function)
We plan to explore each of these topics comprehensively in future articles, allowing for a more in-depth exploration of each.
Research on Long-Term Recovery
I initially hesitated to propose a one-year recovery timeframe in the title; I was concerned it might be seen as overly sensational, almost like something you'd see on a tabloid cover. I initially wrote six months instead of a year.
But then I reviewed the literature.
In one of the first studies looking at long-term physical recovery, Lawrence and colleagues showed that half of patients aged 60 and up will be living with reduced functional capacity six months after major abdominal surgery. This pioneering 2004 study also suggested a significant proportion will never return to independent living.
Now let's take a closer look at a few recent studies that investigated physical function in the first year after surgery. Are the results just as striking with current surgical approaches?
Subjects: 754 community-living persons aged 70+
Surgery: major surgery, elective (59.5%) and nonelective
Results: at 12 months, over 50% of participants had more than 4 functional deficits, compared with only 13% of participants before their operation.
Subjects: 687 participants aged 65+ with and without frailty
Surgery: elective noncardiac surgery with expected length of stay of at least 2 days
Results: at 12 months, 13% of people with frailty were experiencing a new or clinically significantly higher disability, compared with 16% of people without frailty.
Subjects: 1,309 participants aged 40+ who had at least one cardiac risk-factor
Surgery: elective noncardiac surgery
Results: a decline in at least one function was reported by 40% of participants at 30 days and about 1 in 4 (24%) of participants at 1 year.
Subjects: 2,921 adults aged 55+
Surgery: elective noncardiac surgery under general anesthesia
Results: at 90 days, about 1 in 7 participants (13%) reported a significant new disability, with the proportion decreasing to 1 in 10 participants (10%) at 1 year.
Of note: all of these studies relied on patient self-reports, which tend to underestimate disability levels. For instance, in the Lawrence paper referred to above, only 20% of patients self-reported disability at 6 months after surgery, yet objective measurements showed that 40% had significant disability based on a timed walk test, and 50% had significant disability based on grip strength testing.
Research Highlights
To me, what stood out in these studies was the amount of people with a decline in function or new disability impacting their daily life for up to a year.
A few other noteworthy items gleaned from the research:
Many of the patients who had a functional decline at a year did not have a postoperative complication. This is important to know – surgery and immediate recovery might be flawless, and yet it can still take a long time to return to your baseline level of function.
If you unfortunately did have a moderate or severe postoperative complication, this was strongly associated with poor long-term recovery.
The path to full recovery varies greatly after major surgery, but one thing is clear – long-term function depends greatly on the individual's baseline function prior to the operation. Simply put, being in good shape beforehand results in better outcomes.
Now, this is not all doom and gloom. Many patients reported an overall enhancement - while some experienced a functional decline up to a year, that was balanced by others who saw significant improvements.
Why does it take so long for some people to recover and not others? To tackle this question, in my next post we’ll look at factors that could contribute to a prolonged recovery and a little-known method that can accelerate the process.
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