Quality of recovery after surgery in patients with Frailty 
Oliveira, M.; Mendes, L.; Ferraz, S.; Abelha, F.; Santos, A.

Introduction and goal of study
The concept of frailty describes a clinical state of increased vulnerability. This condition has been identified as a significant predictor of adverse postoperative outcome despite surgical and anesthetic advances. The aim of this study was to evaluate the influence of frailty in postoperative recovery.

Materials and Methods
After approval by the institutional ethics committee, an observational, prospective study was performed in patients scheduled for elective surgery. The included patients older than 18 years, undergoing urologic, plastic, gynecologic and general surgery, under general anesthesia, admitted to the Post Anesthetic Care Unit (PACU). Exclusion criteria were: inability to give informed consent and regional anesthesia. Before surgery, patient’s vulnerability was evaluated through the Clinical Frailty Scale and patients were classified as frail patients (FP) if they had a score ≥ 4. The PQRS and the Quality of Recovery 15 score (QoR-15) were used to evaluate the quality of recovery after surgery. PQRS was used at baseline (up to 14 days before surgery) and after surgery at minute 15 (T15), 40 (T40) and days 1 (D1) and 3 (D3) to evaluate recovery in five domains: physiological (PD), nociceptive (ND), emotive (ED), activities of daily living (AD) and cognition (CD). 
Recovery was defined as return to baseline values for all questions in each domain. The Mann-Whitney test, Chi-square or Fisher’s exact test were used for comparisons.

Results
Of 208 patients, 13% were considered FP. FP were older (p<0.001). FP had lower median QoR scores at D0 (118 vs. 123, p=0.003) but at D1 scores were similar. For PD, the rate of recovery was similar in both groups at T15 and T40 but at D1 FP recovered less frequently (33% vs. 59%, p=0.012). FP recovered less frequently in ED at T15 (13% vs. 48%, p=0.001) and at T40 (13% vs. 44%, p=0.002). Postoperative recovery at CD was better in FP at D1 (44% vs. 24%, p=0.023). Rates of recovery for AD were similar at all time frames. 

Conclusion(s)
Patient´s vulnerability and hence their postoperative recovery was evidenced by different rates of recovery in PQRS. FP patients had a worse health status as evidenced by QoR15 before surgery but this scale was not able to identify a poor quality of recovery in frail patients.

Quality of recovery after surgery in patients with frailty