Title: Evaluation of Recovery after Anaesthesia with Postoperative Quality of Recovery Scale

Background and Goal of Study: Postoperative recovery is complete when function is restored and adverse symptoms have resolved. It is a multifactorial process that extends beyond hospital discharge. We aimed to evaluate the relation between early and late recovery using the Postoperative Quality of Recovery Scale (PQRS).

Material and Methods: After approval by the institutional ethics committee, an observational prospective study was conducted. Were studied 208 patients admitted to the Post Anaesthetic Care Unit after plastic, gynaecologic, urologic and general surgery. Exclusion criteria: age <18 years old and inability to give informed consent. PQRS Portuguese version was applied before (T0) and after surgery at minute 15 (T15) and 40 (T40), at day 1 (D1) and 3 (D3) and 3 months (3M) evaluating recovery in five domains: physiological (PD), nociceptive (ND), emotive (ED), cognition (CD) and activities of daily living (AD). Recovery was defined as return to baseline values or better for all questions within each domain. Poor quality of recovery (PQR) was defined as recovery in less than 2 domains at D1. Descriptive analysis was carried and the Mann-Whitney, Chi-square or Fisher’s exact test were used for comparisons.

Results and Discussion: At D1, 182 patients were evaluated with the PQRS. 13.2% patients had PQR. Patients with PQR stayed longer in hospital (p=0.049). There were no differences in age, gender, BMI, ASA status and duration of anaesthesia. For PD domain rate of recovery was similar in both groups at T15 (14% vs 9%, p=0.44) and T40 (14% vs 20%, p=0.77) but at D1 patients with PQR recovered less frequently (21% vs 60%, p<0.001). Recovery at ND was worse in patients with PQR since early recovery (T15) (68% vs 91%, p=0.003) to late recovery (3M) (50% vs 88%, p<0.001). Patients with PQR recovered less frequently in ED at all evaluations times: T15 (16% vs 48%, p=0.012), T40 (5% vs 44%, p=0.001), D1 (0% vs 57%, p<0.001), D3 (19% vs 50%, p=0.018) and 3M (19% vs 50%, p=0.031). Recovery of CD was worst for PQR patients only at D1 (0% vs 27.9%, p <0.001).  Also at D1 patients with PQR had worst recovery in AD (0 vs. 46%, p<0.001), without differences in latter evaluations.

Conclusion(s): The rate of recovery in nociceptive and emotional domains was poor at all time frames for patients with PQR. At 24 hours evaluations PQR patients had worst rate of recovery at all domains of PQRS.

Evaluation of recovery after anaesthesia with Postoperative Quality of Recovery Scale