Prevalence and Predictors of Quality of Recovery at Home After Day Surgery

Abstract

Traditionally, major complications and unanticipated admission/readmission rates were used to assess outcome after day surgery. However, in view of the relative absence of major complications the quality of recovery (QOR) should be considered one of the principal endpoints after day surgery. In our study, the level of QOR is defined by a combination of the Global Surgical Recovery (GSR) Index and the Quality of Life (QOL).The aim of this study was to analyze prevalence and predictors of QOR after day surgery on the fourth postoperative day.Elective patients scheduled for day surgery from November 2008 to April 2010 were enrolled in a prospective cohort study. Outcome parameters were measured by using questionnaire packages at 2 time points: 1 week preoperatively and 4 days postoperatively. Primary outcome parameter is the QOR and is defined as good if the GSR index >80% as well as the postoperative QOL is unchanged or improved as compared with baseline. QOR is defined as poor if both the GSR index ≤80% and if the postoperative QOL is decreased as compared with baseline. QOR is defined as intermediate in all other cases. Three logistic regression analyses were performed to determine predictors for poor QOR after day surgery.A total of 1118 patients were included. A good QOR was noted in 17.3% of patients, an intermediate QOR in 34.8%, and a poor QOR in 47.8% 4 days after day surgery. The best predictor for poor QOR after day surgery was type of surgery. Other predictors were younger age, work status, and longer duration of surgery. A history of previous surgery, expected pain (by the patient) and high long-term surgical fear were significant predictors of poor QOR in only 1 of 3 prediction models.The QOR at home 4 days after day surgery was poor in the majority of patients and showed a significant procedure-specific variation. Patients at risk for poor QOR can be identified during the preoperative period based on type of surgery, age, work status, and the duration of the surgery.

External Validation and Modification of a Predictive Model for Acute Postsurgical Pain at Home After Day Surgery

“…Furthermore, psychological variables (ie, catastrophic thinking, personality trait optimism, fear of potential short-term and long-term consequences of surgery) were analyzed based on 3 validated questionnaires: the Pain Catastrophizing Scale (PCS), the Life Orientation Test Revised (LOT-R) and Surgical Fear Questionnaire 15–18. For the PCS and LOT-R, shortened versions were used to diminish patient burden 15,19. In the PCS questionnaire, 6 of the 13 original items were used.…”

“…In the LOT-R, 4 of the originally 10 questions were used. Four filler questions were omitted and the 4 questions (2 positively phrased and 2 negatively phrased) loading highest on, respectively, the optimism and pessimism factor were selected 15,19. Second, a follow-up questionnaire was used to measure APSP related to the surgery on an 11-point NRS.…”

Pain-related unscheduled contact with healthcare services after outpatient surgery

“…Today, 60–70% of all surgical procedures are performed as outpatient surgery, and this number is likely to increase in future in an ongoing effort to optimise the use of healthcare resources . Outpatient surgery has many advantages over traditional inpatient surgery, including increased convenience for the patient and reduced stress of recovering at home .…”

Virtual postoperative clinic: can we push virtual postoperative care further upstream?

“…The term ‘quality of recovery’ has recently been used to describe the trajectory of a person’s return to baseline function and quality of life following surgery, particularly with respect to limitations in self-care, pain, mood and mobility 6. A practical definition of good quality of recovery is function at 80% or more of baseline, without a drop in quality of life scores at postoperative day four 6. Poor quality of recovery impacts the short-term experience of care and also has long-term implications 8.…”

“…Historically, the quality of postoperative care was defined largely by the absence of major complications 6. Modern surgical and anaesthetic techniques have made major complications following surgery rare.…”