Peer-reviewedCC BY 4.0Surgery Open Science19 Oct 2026

Preoperative predictors of early patient-reported recovery trajectories after major surgery: a secondary analysis of a randomized controlled trial

Miriam van der Velde^1,2
Jessica M. de Graaf²
Edwin Geleijn³
Karin Valkenet^1,2
Marike van der Leeden^3,4

4 affiliations

¹Research Group Innovation of Human Movement Care, Center for Healthy and Sustainable Living, HU University of Applied Sciences, Heidelberglaan 7, Utrecht, 3584 CS, the Netherlands
²Department of Rehabilitation, Physical Therapy Science and Sports, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, the Netherlands
³Department of Rehabilitation Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, the Netherlands
⁴Amsterdam Movement Sciences, Ageing and Vitality, De Boelelaan 1117, Amsterdam, 1081 HV, the Netherlands

Abstract

Objective: To examine recovery trajectories of Physical Functioning (PF) and the Ability to Participate in Social Roles and Activities (APS) after major surgery, and identify preoperative predictors.

Background: Recovery after major surgery is typically evaluated at isolated time points, limiting insight into recovery dynamics. Understanding recovery trajectories and their determinants may inform prognostic model development.

Methods: This exploratory secondary analysis used data from a multicenter randomized controlled trial including adults undergoing major elective surgery. Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test PF and APS were assessed preoperatively and at 1, 3, 6, and 12 weeks post discharge. Recovery trajectories were modeled using linear mixed effects models with random intercepts and slopes. Preoperative characteristics were examined using interaction terms for time and time2.

Results: Among 369 patients, PF and APS followed curvilinear patterns. For PF, older age (β = −0.04, 95% CI [−0.06 to −0.02]), unintentional weight loss and higher comorbidity were associated with slower recovery. Higher baseline PF predicted with faster recovery. Differences exceeding the Minimal Important Change (MIC) were observed for age and baseline PF.

For APS, older age was also associated with slower recovery (β = −0.04, 95% CI [−0.08 to −0.004]), and intermediate education (vs low) with differences in recovery curvature. Higher baseline APS predicted higher postoperative scores. MIC-exceeding differences were observed for baseline APS and age.

Conclusions: Early postoperative recovery is curvilinear. Multiple preoperative factors were associated with recovery trajectories, supporting their role as candidate predictors for future trajectory-based prognostic models.

Trial registration: This study was approved by the Medical Ethical Committee of Amsterdam University Medical Center, location VUmc, under registration number NL61503.029.18.

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Cite

BibTeX RIS

BibTeX

@article{velde2026preoperative,
  title = {{Preoperative predictors of early patient-reported recovery trajectories after major surgery: a secondary analysis of a randomized controlled trial}},
  author = {Miriam van der Velde and Jessica M. de Graaf and Edwin Geleijn and Karin Valkenet and Marike van der Leeden},
  journal = {Surgery Open Science},
  year = {2026},
  month = oct,
  doi = {10.1016/j.sopen.2026.10.002},
  url = {https://doi.org/10.1016/j.sopen.2026.10.002},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Preoperative predictors of early patient-reported recovery trajectories after major surgery: a secondary analysis of a randomized controlled trial
AU  - Miriam van der Velde
AU  - Jessica M. de Graaf
AU  - Edwin Geleijn
AU  - Karin Valkenet
AU  - Marike van der Leeden
PY  - 2026
DA  - 2026/10/19
JO  - Surgery Open Science
DO  - 10.1016/j.sopen.2026.10.002
UR  - https://doi.org/10.1016/j.sopen.2026.10.002
AB  - Objective: To examine recovery trajectories of Physical Functioning (PF) and the Ability to Participate in Social Roles and Activities (APS) after major surgery, and identify preoperative predictors.  Background: Recovery after major surgery is typically evaluated at isolated time points, limiting insight into recovery dynamics. Understanding recovery trajectories and their determinants may inform prognostic model development.  Methods: This exploratory secondary analysis used data from a multicenter randomized controlled trial including adults undergoing major elective surgery. Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test PF and APS were assessed preoperatively and at 1, 3, 6, and 12 weeks post discharge. Recovery trajectories were modeled using linear mixed effects models with random intercepts and slopes. Preoperative characteristics were examined using interaction terms for time and time2.  Results: Among 369 patients, PF and APS followed curvilinear patterns. For PF, older age (β = −0.04, 95% CI [−0.06 to −0.02]), unintentional weight loss and higher comorbidity were associated with slower recovery. Higher baseline PF predicted with faster recovery. Differences exceeding the Minimal Important Change (MIC) were observed for age and baseline PF.  For APS, older age was also associated with slower recovery (β = −0.04, 95% CI [−0.08 to −0.004]), and intermediate education (vs low) with differences in recovery curvature. Higher baseline APS predicted higher postoperative scores. MIC-exceeding differences were observed for baseline APS and age.  Conclusions: Early postoperative recovery is curvilinear. Multiple preoperative factors were associated with recovery trajectories, supporting their role as candidate predictors for future trajectory-based prognostic models.  Trial registration: This study was approved by the Medical Ethical Committee of Amsterdam University Medical Center, location VUmc, under registration number NL61503.029.18.
SN  - 2589-8450
ER  -

Abstract

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