Abstract：
Traditional risk factors used for predicting poor postoperative recovery have focused on postoperative complications, adverse symptoms (nausea, pain), length of hospital stay, and patient quality of life. Despite these being traditional performance indicators of patient postoperative \"status,\" they may not fully define the multidimensional nature of patient recovery. The definition of postoperative recovery is thus evolving to include patient-reported outcomes that are important to the patient. Previous reviews have focused on risk factors for the above traditional outcomes after major surgery. Yet, there remains a need for further study of risk factors predicting multidimensional patient-focused recovery, and investigation beyond the immediate postoperative period after patients are discharged from the hospital. This review aimed to appraise the current literature identifying risk factors for multidimensional patient recovery.
METHODS: A systematic review without meta-analysis was performed to qualitatively summarize preoperative risk factors for multidimensional recovery 4-6 weeks after major surgery (PROSPERO, CRD42022321626). We reviewed three electronic databases between January 2012 and April 2022. The primary outcome was risk factors for multidimensional recovery at 4-6 weeks. A GRADE quality appraisal and a risk of bias assessment were completed.
RESULTS: In total, 5150 studies were identified, after which 1506 duplicates were removed. After the primary and secondary screening, nine articles were included in the final review. Interrater agreements between the two assessors for the primary and secondary screening process were 86% (k = 0.47) and 94% (k = 0.70), respectively. Factors associated with poor recovery were found to include ASA grade, recovery tool baseline score, physical function, number of co-morbidities, previous surgery, and psychological well-being. Mixed results were reported for age, BMI, and preoperative pain. Due to the observational nature, heterogeneity, multiple definitions of recovery, and moderate risk of bias of the primary studies, the quality of evidence was rated from very low to low.
CONCLUSIONS: Our review found that there were few studies assessing preoperative risk factors as predictors for poor postoperative multidimensional recovery. This confirms the need for higher quality studies assessing risk for poor recovery, ideally with a consistent and multi-dimensional definition of recovery.
METHODS: A systematic review without meta-analysis was performed to qualitatively summarize preoperative risk factors for multidimensional recovery 4-6 weeks after major surgery (PROSPERO, CRD42022321626). We reviewed three electronic databases between January 2012 and April 2022. The primary outcome was risk factors for multidimensional recovery at 4-6 weeks. A GRADE quality appraisal and a risk of bias assessment were completed.
RESULTS: In total, 5150 studies were identified, after which 1506 duplicates were removed. After the primary and secondary screening, nine articles were included in the final review. Interrater agreements between the two assessors for the primary and secondary screening process were 86% (k = 0.47) and 94% (k = 0.70), respectively. Factors associated with poor recovery were found to include ASA grade, recovery tool baseline score, physical function, number of co-morbidities, previous surgery, and psychological well-being. Mixed results were reported for age, BMI, and preoperative pain. Due to the observational nature, heterogeneity, multiple definitions of recovery, and moderate risk of bias of the primary studies, the quality of evidence was rated from very low to low.
CONCLUSIONS: Our review found that there were few studies assessing preoperative risk factors as predictors for poor postoperative multidimensional recovery. This confirms the need for higher quality studies assessing risk for poor recovery, ideally with a consistent and multi-dimensional definition of recovery.
摘要：
传统的预测术后恢复不良的危险因素主要集中在术后并发症。不良症状（恶心，疼痛),住院时间,和患者的生活质量。尽管这些是患者术后状态的传统性能指标，他们可能无法完全定义患者康复的多维性质。因此，术后恢复的定义正在演变为包括对患者重要的患者报告结果。以前的综述集中在大手术后上述传统结果的危险因素。然而，仍然需要进一步研究预测多维患者康复的风险因素，以及患者出院后术后即刻的调查。这篇综述旨在评估当前文献中确定多维患者康复的危险因素。
方法：进行了无荟萃分析的系统评价，以定性总结大手术后4-6周多维恢复的术前危险因素（PROSPERO，CRD42022321626）。我们审查了2012年1月至2022年4月之间的三个电子数据库。主要结果是4-6周时多维恢复的危险因素。完成了等级质量评估和偏见风险评估。
结果：总计，确定了5150项研究，之后，删除了1506个重复项。经过一级和二级筛查，最终审查包括9篇文章。两个评估者之间的一级和二级筛选过程的中间协议是86％（k=0.47）和94％（k=0.70），分别。发现与不良恢复相关的因素包括ASA等级，恢复工具基线评分,物理功能，合并症的数量，以前的手术，和心理健康。据报道，年龄的结果喜忧参半，BMI,和术前疼痛。由于观测性质，异质性，恢复的多个定义，和初级研究的中等偏倚风险，证据质量从很低到很低.
结论：我们的综述发现，很少有研究评估术前危险因素作为术后多维恢复不良的预测因素。这证实了需要更高质量的研究来评估不良恢复的风险，理想情况下，具有一致和多维的恢复定义。
方法：进行了无荟萃分析的系统评价，以定性总结大手术后4-6周多维恢复的术前危险因素（PROSPERO，CRD42022321626）。我们审查了2012年1月至2022年4月之间的三个电子数据库。主要结果是4-6周时多维恢复的危险因素。完成了等级质量评估和偏见风险评估。
结果：总计，确定了5150项研究，之后，删除了1506个重复项。经过一级和二级筛查，最终审查包括9篇文章。两个评估者之间的一级和二级筛选过程的中间协议是86％（k=0.47）和94％（k=0.70），分别。发现与不良恢复相关的因素包括ASA等级，恢复工具基线评分,物理功能，合并症的数量，以前的手术，和心理健康。据报道，年龄的结果喜忧参半，BMI,和术前疼痛。由于观测性质，异质性，恢复的多个定义，和初级研究的中等偏倚风险，证据质量从很低到很低.
结论：我们的综述发现，很少有研究评估术前危险因素作为术后多维恢复不良的预测因素。这证实了需要更高质量的研究来评估不良恢复的风险，理想情况下，具有一致和多维的恢复定义。
