title: 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.
authors.affiliation: From the Department of Anesthesiology, Jessa Hospital, Hasselt, Belgium (BS) and Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands (BS, AAF, EAJ, DMNH, H-FG, WFFAB).
authors.forename: Björn
authors.initials: B
authors.lastname: Stessel
authors.forename: Audrey A
authors.initials: AA
authors.lastname: Fiddelers
authors.forename: Elbert A
authors.initials: EA
authors.lastname: Joosten
authors.forename: Daisy M N
authors.initials: DMN
authors.lastname: Hoofwijk
authors.forename: Hans-Fritz
authors.initials: HF
authors.lastname: Gramke
authors.forename: Wolfgang F F A
authors.initials: WFFA
authors.lastname: Buhre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D055815:Young Adult