How well are we measuring postoperative ‘‘recovery’’ after abdominal surgery? Lawrence Lee 1 • Teodora Dumitra 1 • Julio F. Fiore Jr. 1,2 • Nancy E. Mayo 2 • Liane S. Feldman 1 Accepted: 28 April 2015 / Published online: 24 May 2015 Ó Springer International Publishing Switzerland 2015 Abstract Purpose The content validity of patient-reported out- comes (PROs) commonly used to measure postoperative recovery is unknown. The objective of this study was to develop a conceptual framework for recovery after ab- dominal surgery and to analyze the content of PRO in- struments against this conceptual framework. Methods Qualitative methods were used to develop a conceptual framework for recovery. Patients undergoing abdominal surgery and healthcare professionals were in- terviewed. Recovery-related concepts were identified using a thematic analysis, and concepts were then linked to the International Classification of Functioning, Disability and Health (ICF). The contents of eight PRO instruments that have been used to measure recovery were then examined using this conceptual framework. Results A total of 17 patients and 15 healthcare profes- sionals were interviewed. A total of 22 important recovery- related concepts were identified and linked to the ICF. The four most important concepts were ‘‘Energy level,’’ ‘‘Sensation of pain,’’ ‘‘General physical endurance,’’ and ‘‘Carrying out daily routine.’’ The number of important recovery-related concepts covered by each instrument ranged from 1 to 22 (mean 7.3 concepts). The SF36 (n = 22), European Organization for the Treatment and Research of Cancer Quality-of-Life Questionnaire-C30 (n = 20), and the Gastrointestinal Quality-of-Life Index (n = 19) covered the greatest number of important recov- ery concepts. No instrument covered all of the important concepts. Conclusions The comparison of the contents of PRO in- struments commonly used to measure postoperative re- covery after abdominal surgery demonstrated major gaps in the representation of concepts that are important to patients and healthcare professionals. Keywords Recovery Á Function Á ICF Á Quality of life Á Content validity Introduction Postoperative recovery is a complex construct involving dimensions of physical, emotional and social health [1]. Many innovations in abdominal surgery such as enhanced recovery pathways (ERPs) and laparoscopic surgery aim to improve recovery, but much of the data on the effective- ness of these interventions have focused on traditional clinical and audit measures (e.g., postoperative complica- tions and hospital length of stay) [2]. Although these measures are of interest for clinicians, they do not capture the complexity of the construct ‘‘recovery’’ or the per- spective of patients, i.e., those who are actually recovering. Taking this into account, recent literature has advocated that recovery be measured using patient-reported outcomes [1–4] (PROs; any report of the status of a patients’ health condition that comes directly from the patient [5]). Using PROs in the context of recovery provides the opportunity to monitor perioperative health status across various & Lawrence Lee larry.lee@mail.mcgill.ca 1 Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, 1650 Cedar Ave, E19-125, Montreal, QC H3G 1A4, Canada 2 Division of Clinical Epidemiology, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, QC, Canada 123 Qual Life Res (2015) 24:2583–2590 DOI 10.1007/s11136-015-1008-5