Recovery of physical and mental health within 4 weeks after colorectal surgery: a prospective cohort study

Colorectal surgery substantially impacts patients' physical and mental health. However, the timeframe for recovery in contemporary care settings remains poorly understood. This study aimed to (1) estimate the proportion of patients who return to baseline health within 4 weeks after colorectal surgery and (2) identify predictors of incomplete recovery.

In this prospective cohort study, adults undergoing elective colorectal surgery were recruited at two university-affiliated hospitals where procedures are predominantly minimally invasive and care follows enhanced recovery principles. Participants completed the PROMIS-29 survey preoperatively and weekly through postoperative week (POW) 4. Physical Health Summary (PHS) and Mental Health Summary (MHS) scores were derived. Recovery was defined as achieving a PHS or MHS score within 3 points (minimally important difference) of the baseline value by POW4. Descriptive statistics estimated the proportion of patients recovering to baseline. Generalized estimating equations (GEE) identified predictors of incomplete recovery (decline ≥ 3 points through POW4).

282 patients were included (58 ± 15; 48% female; 78% laparoscopic; 20% new stoma; 34% complications). By POW4, 74% of patients (n = 209) met the recovery threshold for physical health and 87% (n = 245) for mental health. Delayed physical recovery was associated with female sex (OR 1.93; 95%CI 1.25-2.99; p = 0.003), ASA class III-IV (OR 1.91; 95%CI 1.13-3.23; p = 0.016), open surgical approach (OR 2.10; 95%CI 1.14-3.86; p = 0.017) and 30-day complications (OR 1.68; 95% CI 1.02-2.76; p = 0.042). Delayed mental recovery was associated with ASA class III-IV (OR 1.96; 95%CI 1.12-3.43; p = 0.019) and 30-day complications (OR 1.75; 95% CI 1.02-3.01; p = 0.044).

In the context of enhanced recovery and widespread minimally invasive surgery, most patients undergoing colorectal surgery regained baseline physical and mental health within 4 weeks after surgery. Patients at risk of slower recovery may warrant closer follow-up and tailored strategies to optimize outcomes.