Short-term health-related quality of life after abdominal surgery: a conceptual framework

We sought to develop a conceptual framework of health-related quality of life (QOL) after abdominal surgery to assist in the development of a QOL measure suitable for use in clinical trials comparing laparoscopic and conventional surgery. We conducted semi-structured interviews with 21 patients within 2 weeks after an abdominal surgical procedure. Responses were transferred into an electronic spreadsheet and coded to facilitate analysis. We tabulated the frequency of similar responses and grouped response items into areas of QOL impairment. The patients ranged in age from 19 to 78 years. Six had laparoscopic procedures. Patients identified the following areas of QOL impairment (examples of specific items and frequency of response): (1) physical limitations (difficulty getting in and out of bed 52%, difficulty walking 48%), (2) functional impairment (inability to perform usual activities 100%, difficulty bathing 90%), (3) pain (pain in incision 48%, pain with coughing or movement 28%), (4) visceral function (inability to eat 48%, lack of appetite 43%), (5) sleep (frequent nighttime awakening 62%, difficulty falling asleep 33%), and (6) mood (helplessness 28%, anxiety 24%). Acute health status after abdominal surgery constitutes a unique, dynamic health state characterized by impairment in a number of different health domains. A measure of QOL after abdominal surgery should have adequate coverage of these health concepts.