Omar Omar, Kamarajah Sivesh Kathir
NIHR Global Health Research Unit on Global Surgery, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMC Surg. 2025 Aug 29;25(1):399. doi: 10.1186/s12893-025-03079-1.
Recovery after major surgery is a key priority identified by patients, communities and policymakers in low- and middle-income countries (LMICs), with important societal and financial implications. With global burden of surgical diseases rising, little is known about how well patients return to normal activities after surgery in these settings. This study aimed to describe patterns of return to normal activity after major abdominal surgery and identify associated factors in LMICs.
This was a pre-planned analysis of a cluster-randomised randomised trial testing routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection in seven LMICs (India, Mexico, Rwanda, Benin, South Africa, Nigeria, Ghana). 961 patients were excluded because of incomplete missing primary outcome. The primary outcome measure was a patients self-reported full return to their normal activities at 30 days after surgery. Factors associated with return to normal activities within 30-days of surgery was explored using a Bayesian mixed-effects logistic regression model. Sensitivity analyses were performed accounting for missing data.
12,340 patients across 81 centres were included. Overall, 65.3% (8064/12340) patients had returned to normal activity by 30-days after surgery. Patients undergoing surgery for benign than cancer surgery (67.0% vs. 59.7%), minor compared to major surgery (71.0% vs. 63.5%), and non-midline compared to midline (74.9% vs. 58.7%) had higher rates of return to normal activities within 30-days from abdominal surgery. In an adjusted model, factors associated with return to normal activities are benign surgery (OR: 0.61, 95% CI: 0.53-0.71), minor surgery (OR: 0.56, 95% CI: 0.49-0.64), and non-midline operations (OR: 1.57, 95% CI: 1.41-1.75). When accounting for missing data, consistent findings were observed.
With rising need for surgical care and non-communicable disease globally, this study highlights the groups of patients at critical need for improving return to normal activity or recovery after surgery in LMICs. Improving access and implementation of rehabilitation pathways, aligned to the World Health Organisation, may be crucial to improve financial risk protection to patient and reduce productivity loss to the economy.
在低收入和中等收入国家（LMICs），大手术后的康复是患者、社区和政策制定者确定的关键优先事项，具有重要的社会和经济影响。随着全球外科疾病负担的增加，对于这些地区患者术后恢复正常活动的情况知之甚少。本研究旨在描述大腹部手术后恢复正常活动的模式，并确定低收入和中等收入国家的相关因素。
这是一项对一项整群随机试验的预先计划分析，该试验在腹部伤口缝合时测试常规无菌手套和器械更换，以预防七个低收入和中等收入国家（印度、墨西哥、卢旺达、贝宁、南非、尼日利亚、加纳）的手术部位感染。961名患者因主要结局数据不完整而被排除。主要结局指标是患者自我报告在术后30天完全恢复正常活动。使用贝叶斯混合效应逻辑回归模型探讨与术后30天内恢复正常活动相关的因素。对缺失数据进行了敏感性分析。
纳入了81个中心的12340名患者。总体而言，65.3%（8064/12340）的患者在术后30天恢复了正常活动。接受良性手术而非癌症手术的患者（67.0%对59.7%）、接受小手术而非大手术的患者（71.0%对63.5%）以及接受非中线手术而非中线手术的患者（74.9%对58.7%）在腹部手术后30天内恢复正常活动的比例更高。在调整模型中，与恢复正常活动相关的因素是良性手术（比值比：0.61，95%置信区间：0.53 - 0.71）、小手术（比值比：0.56，95%置信区间：0.49 - 0.64）和非中线手术（比值比：1.57，95%置信区间：1.41 - 1.75）。在考虑缺失数据时，观察到了一致的结果。
随着全球对外科护理和非传染性疾病需求的增加，本研究强调了在低收入和中等收入国家中迫切需要改善术后恢复正常活动或康复的患者群体。按照世界卫生组织的要求，改善康复途径的可及性和实施可能对于改善患者的财务风险保护以及减少经济生产力损失至关重要。
