Objectives: To better understand the relationships between case-mix, processes of care, and recovery after laparoscopic surgery.
Methods: Patient recovery was prospectively measured among patients undergoing laparoscopic nephrectomy (n = 308), partial nephrectomy (n = 81), nephroureterectomy (n = 30), and cyst decortication (n = 46). Convalescence was measured using the SF-12 and visual analog pain scales administered preoperatively and at 2 and 6 weeks postoperatively. Patient-reported time to events (eg, driving, normal, nonstrenuous activity) were also measured. Mixed models (SF-12 and pain scores) and Cox proportional hazards models (time to event) were fit to determine the association of case-mix and processes of care with the recovery measures.
Results: With the exception of mental health, all convalescence measures demonstrated significant variability across procedure type. The time to return to normal, nonstrenuous activity was 12.8 +/- 9.8, 11.9 +/- 9.2, 21.6 +/- 11.9, and 12.0 +/- 9.0 days for patients undergoing nephrectomy, partial nephrectomy, nephroureterectomy, and cyst decortication, respectively (P < 0.01). The baseline scores were robust predictors of physical, mental, and pain recovery (all P < 0.01). The surgical approach was associated with postoperative pain recovery and return to normal activity (all P < 0.05). Compared with the preoperative characteristics, the perioperative processes of care did not explain the additional variation in any of the recovery measures.
Conclusions: The variation in recovery among the various laparoscopic kidney procedures is significant. The baseline health status of the patient and the preoperative processes (planned procedure, planned surgical approach) strongly influence postoperative recovery.