Introduction and goal of study
Postoperative recovery is a complex process related to various outcomes, such as physiological end-points, and change in psychological status. Quality of postoperative recovery may be viewed as an important outcome after surgery and anesthesia. We aimed to assess and compare the quality of postoperative recovery and the health status before and after surgery in patients scheduled for elective surgery.

Methods
After approval by the institutional ethics committee, an observational, prospective study was conducted including patients submitted to elective surgery. Inclusion criteria were: patients older than 18 years, undergoing non-cardiac, non-obstetric and non-neurological surgery, admitted to the Post Anesthetic Care Unit (PACU) between June and August of 2015. Exclusion criteria included inability to give informed consent and regional anesthesia. Patients were evaluated for perioperative characteristics and the Portuguese version of Postoperative Quality of Recovery Scale (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) evaluating recovery in several domains. Recovery was defined as return to baseline values or better for all questions within each domain; this was done for all the domains together and for each individually. Poor quality of recovery (PQR) was defined as recovery in less than 2 domains at D1.The health status was assessed by the EQ-5D and by the World Health Organization Disability Assessment Schedule (WHODAS) score 2.0 at baseline (up to 14 days before surgery – D0) and 3 months after surgery (3M). Patients with WHODAS score ≥ 25 at 3M evaluation were considered to have disability. The Mann-Whitney test, Chi-square or Fisher’s exact test were used for comparisons.

Results
From 206 patients observed 182 were included in the study. At D1 patients with PQR had median VAS scores for EQ-5D similar to other patients (73 vs. 80, p=0.314) but they had more problems in mobility (33% vs. 14%, p=0.017), usual activities (29% vs. 13%, p=0.045), pain/ discomfort (50% vs. 20%, p=0.002) and anxiety/depression (88% vs. 55%, p=0.002). At 3M evaluation patients with PQR had median VAS scores for EQ-5D similar to other patients (80 vs. 80, p=0.945) but they had more problems with pain (44% vs. 21%, p=0.046). Patients with PQR had higher median WHODAS scores indicating worse health status at D0 (5.2 vs. 2.1, p=0.035) but at 3M evaluation scores were similar (2.1 vs. 2.1, p=0.964). PQR patients were not more frequently disable. 

Conclusion 
Patients with PQR had worst health status at D0 according to rate of problems in EQ-5D and to WHODAS scores, but at 3M evaluations their rates of problems in EQ-5D (except for pain) and their WHODAS scores were similar.

Quality of postoperative recovery and health status in patients scheduled for elective surgery