Evaluation of the quality of recovery and the postoperative health status after elective surgery

Ferraz, Sofia M.; Moreira, João P.; Mendes, Leonor C.; Amaral, Tania M.; Andrade, Ana R.; Santos, Alice R.; Abelha, Fernando J.

doi:10.1016/j.bjane.2018.06.002

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Scientific Articles • Rev. Bras. Anestesiol. 68 (6) • Nov-Dec 2018 • https://doi.org/10.1016/j.bjane.2018.06.002 copy

Evaluation of the quality of recovery and the postoperative health status after elective surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Purpose:

Postoperative recovery is a complex process with physiologic, functional, and psychologic dimensions. Postoperative quality of recovery is considered as a crucial outcome following surgery and anesthesia. The objective of this study was to assess and compare the quality of postoperative recovery and health status before and after surgery, in patients undergoing elective surgery.

Methods:

This observational, prospective study was conducted on patients proposed for elective surgery. Evaluation of postoperative recovery was performed using the Postoperative Quality of Recovery Scale and health status was assessed by applying the EuroQol assessing problems in five dimensions: mobility, personal care, usual activities, pain/discomfort, and anxiety/depression, and the World Health Organization Disability Assessment Schedule 2.0. Poor quality of recovery was defined as recovery in fewer than two domains at postoperative Day 1 in the Postoperative Quality of Recovery Scale.

Results:

Before surgery (D0), patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they had more problems in the mobility, usual activities, pain/discomfort, and anxiety/depression dimensions. At 3 months after surgery, patients with poor quality of recovery had median Visual Analog Scale scores in EuroQol similar to those of patients without poor quality of recovery, but they maintained more problems in the pain/discomfort dimension. Patients with poor quality of recovery scored significantly higher on the World Health Organization Disability Assessment Schedule 2.0 scale at baseline, although the results were similar at 3 months.

Conclusions:

Patients with poor quality of recovery had the worst health status at D0. Evaluation at 3 months indicated similar rates of problems in EuroQol (except for pain/discomfort) and World Health Organization Disability Assessment Schedule 2.0 scores were similar.

KEYWORDS
Postoperative recovery; Poor quality of recovery; Health status; WHODAS; EQ-5D

Surgery	Absolut frequency (n = 182)
Gynaecologic	32
Head and neck	13
Gastrointestinal	82
Urologic	10
Breast	32
Plastic and reconstructive	13

Domain	PQR (n = 24) 13.2%	Without PQR (n = 158) 86.8%	p
Physiological	5 (21)	95 (60)	<0.001^a a Chi-square test.
Cognitive	0 (0)	44 (28)	0.001^b b Fisher's exact test
Emotive	0 (0)	90 (57)	<0.001^b b Fisher's exact test
Nociceptive	15 (63)	146 (92)	<0.001^a a Chi-square test.
Activities of daily living	1 (4)	73 (46)	<0.001^b b Fisher's exact test

	PQR (n = 24) 13.2%	Without PQR (n = 158) 86.8%	p
Age (years) median (IQR)	63 (47-70)	56 (54-64)	0.081^b b Mann-Whitney U-test.
Sex, n (%)			0.399^a a Chi-square test.
Female	14 (58.3%)	106 (67.1%)
Male	1 0 (41.7%)	52 (32.9%)
ASA, n (%)			0.432^a a Chi-square test.
I	2 (8.3)	19 (12.0)
II	15 (62.5)	113 (71.5)
III	7 (29.2)	25 (15.8)
IV	-	1 (0.6)
BMI, median (IQR)	25.8 (24.4-30.8)	26.9 (23.5-30.5)	0.736^b b Mann-Whitney U-test.
Duration of anesthesia (min), median (IQR)	148.0 (120.0-193.0)	144.5 (110.0-180.0)	0.437^b b Mann-Whitney U-test.
Duration of PACU stay (min), median (IQR)	127.5 (90.8-341.3)	120.0 (92.3-158.5)	0.607^b b Mann-Whitney U-test.
Duration of hospital stay (days), median (IQR)	6.5 (3.0-14.0)	5.0 (3.0-7.0)	0.049^b b Mann-Whitney U-test.

	PQR (n = 24)	Without PQR (n = 158)	p
WHODAS	5.2 (4.2-13.0)	2.1 (0-8.3)	0.015^a a Mann-Whitney U-test.

	PQR (n = 16)	Without PQR (n = 124)	p
WHODAS	2.1 (0-4.2)	2.1 (0-6.3)	0.964^a a Mann-Whitney U-test.

Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org

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[1] * Corresponding author. E-mail:fernando.abelha@gmail.com (F.J. Abelha).