Baker Daniel M, Chapman Stephen J, Thomas Benjamin D, Thompson Benjamin J, Hawkins Deborah J, Arnott Robert, Blackwell Sue, Thorpe Gabrielle, Harji Deena P, Jones Georgina L, Lee Matthew J
Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK.
Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
Colorectal Dis. 2023 Oct;25(10):2024-2032. doi: 10.1111/codi.16715. Epub 2023 Aug 21.
Patients admitted to hospital for abdominal surgery often experience gastrointestinal dysfunction. Many studies have reported outcomes following gastrointestinal dysfunction, yet there is no unified definition of recovery or a validated patient-reported outcome measure (PROM). The first stage of PROM development requires formation of a conceptual framework to identify key themes to patients. The aim of this study was to utilize semistructured interviews to identify core themes and concepts relevant to patients to facilitate development of a conceptual framework.
Adult patients admitted to hospital for major gastrointestinal, urological or gynaecological surgery, in an emergency or elective setting, were eligible to participate. Patients treated nonoperatively for small bowel obstruction were also eligible. Interviews were conducted by telephone, audio-recorded, transcribed, coded and analysed using NVivo software by two researchers and reviewed by lay members of the steering group. Interviews continued until data saturation was reached. Ethical approval was gained prior to interviews (21/WA/0231).
Twenty nine interviews were completed (17 men, median age 64 years) across three specialties (20 gastrointestinal, six gynaecological, three urological). Two overarching themes of 'general recovery' and 'gastrointestinal symptoms' were identified. General recovery included three themes: 'life impact', 'mental impact', including anxiety, and 'physical impact', including fatigue. Gastrointestinal symptoms included three themes: 'abdominal symptoms' such as pain, 'diet and appetite' and 'expulsory function', such as stool frequency. A total of 18 gastrointestinal symptoms were identified during patient recovery-many of which lasted several weeks following discharge.
This study reports a range of gastrointestinal and nongastrointestinal symptoms experienced by patients during early gastrointestinal recovery. Identified symptoms have been synthesized into a conceptual framework to enable development of a definitive PROM for early gastrointestinal recovery.
因腹部手术入院的患者常出现胃肠功能障碍。许多研究报告了胃肠功能障碍后的结果，但对于恢复尚无统一的定义，也没有经过验证的患者报告结局指标（PROM）。PROM 开发的第一阶段需要形成一个概念框架，以确定对患者至关重要的主题。本研究的目的是利用半结构化访谈来确定与患者相关的核心主题和概念，以促进概念框架的开发。
因重大胃肠、泌尿或妇科手术入院的成年患者，无论急诊或择期手术，均符合参与条件。因小肠梗阻接受非手术治疗的患者也符合条件。访谈通过电话进行，录音、转录、编码并由两名研究人员使用 NVivo 软件进行分析，指导小组的非专业成员进行审核。访谈持续进行直至达到数据饱和。访谈前获得了伦理批准（21/WA/0231）。
完成了 29 次访谈（17 名男性，中位年龄 64 岁），涉及三个专科（20 例胃肠手术患者、6 例妇科手术患者、3 例泌尿外科手术患者）。确定了“总体恢复”和“胃肠道症状”两个总体主题。总体恢复包括三个主题：“生活影响”、“心理影响”（包括焦虑）和“身体影响”（包括疲劳）。胃肠道症状包括三个主题：“腹部症状”（如疼痛）、“饮食和食欲”以及“排泄功能”（如排便频率）。在患者恢复期间共确定了 18 种胃肠道症状，其中许多症状在出院后持续数周。
本研究报告了患者在胃肠道早期恢复过程中经历的一系列胃肠道和非胃肠道症状。已将所确定的症状整合到一个概念框架中，以便为胃肠道早期恢复开发一个确定的 PROM。
