Quality of patient-centred recovery trajectories after different types of surgery: a prospective cohort study.

Abstract

We sought to measure patient recovery trajectory up to 90 days after surgery using both the 15-item quality of recovery score (QoR-15) (range 0-150) and the number of days alive and at home up to 30 days after surgery (DAH₃₀). This prospective cohort study included adult patients undergoing either elective intermediate (mostly arthroplasty) or cardiac surgery, or day case gastroscopy (control group). We asked eligible patients to record their QoR-15 scores before their procedure and then daily via smartphone text messaging for 2 weeks, then weekly for 2 weeks, and then monthly up to 90 days after their procedure to track recovery trajectory. We also recorded their DAH₃₀. The co-primary endpoints were differences in the nadir and slope of the trajectory of recovery as measured by the QoR-15 scale. Differences between groups were compared using time series analysis. Of 199 eligible and consenting patients who underwent surgery, 188 (94%) had complete follow-up. Median (interquartile range) nadir QoR-15 scores were 128 (93-145), 87 (70-102), and 70 (60-81) for the gastroscopy, intermediate, and cardiac surgery groups, respectively (P<0.001). Compared with the gastroscopy group (29.9 [29.9-29.9]), the median (IQR) DAH₃₀ was lower in both the intermediate (28.8 [26.1-29.1]) and cardiac (22.9 [18.9-24.1]) surgery groups (each P<0.001). There was an association between the QoR-15 nadir and DAH₃₀ (rho=0.52, P<0.001). Most patients were very satisfied or satisfied with the frequent text messaging. Recovery after surgery varies according to the extent of surgery and the presence of postoperative complications. Follow-up and measurement of recovery was highly valued by patients. Open Science Framework (https://doi.org/10.17605/OSF.IO/ANBJ5).