Purpose: To quantify patient preferences for multiple attributes of recovery following abdominal surgery, using a discrete choice experiment (DCE).
Methods: US respondents who self-reported having major abdominal surgery (such as surgeries for rectal, bowel or colon cancer, uterine fibroids, Crohn’s disease) and requiring hospitalization in the previous 3 years completed an online DCE survey. Respondents were presented with 10 pairs of abdominal surgery recovery scenarios, each one described using 4 attributes: bowel related symptoms (none, mild, moderate, or severe), number of additional hospital days due to delayed bowel recovery (0, 2, 4, or 7), indigestion (none, mild, or moderate to severe), and copayment for hospital stay (range: $0 - $1500). Preference weights were estimated using mixed-logit and used to calculate the relative importance of changes in recovery scenario attributes and maximum willingness to pay (WTP) for changes in recovery scenarios.
Results: 387/400 respondents were included in the analysis. Mean age: 45 years (SD = 14); 69% female; 67% reported a prior bowel resection surgery. The respondents indicated a preference to avoid symptoms of delayed bowel recovery and indigestion, and to avoid additional hospital days and higher copayments for hospital stays. The preference weights for moderate severity were statistically different than the weights for mild and severe (P < 0.05), regardless of the number of additional hospital days, suggesting that respondents perceived differences between severity levels. The relative importance of improving symptoms associated with bowel recovery from moderate to mild or from severe to moderate increased with additional hospital days. An improvement in symptoms from moderate to mild symptoms with 2, 4, and 7 additional hospital days was 1.4, 1.8, and 2.4 times as important as improving symptoms from moderate to mild with no additional hospital days. The relative importance of improving symptoms from severe to moderate was 1.5 times as important as improving symptoms from moderate to mild, regardless of the number of additional hospital days. Mean WTP to avoid worsening symptoms from mild to moderate ranged from $93 (95% CI: $33-153) with no additional hospital days to $224 (95% CI: $80-367) with 7 additional hospital days. While preferences for the subset of respondents who had a previous bowel resection were generally similar to those who experienced non resective therapy, avoiding hospital days was relatively more important to those who experienced non resective therapy (P < 0.01).
Conclusions: When assessed by DCE questioning, patients valued reducing the symptoms experienced with delayed bowel recovery and avoiding additional hospital days. This may assist to focus preoperative patient-physician discussions regarding recovery expectations and priorities following major abdominal surgery.
