Early Quality of Recovery and Associated Factors in Day-Case Surgery Patients: A Prospective Observational Study in Vietnam

Abstract

Background: Outpatient surgery is expanding worldwide, but early discharge limits the assessment of multidimensional recovery, especially in low-resource settings. Objectives: This study evaluated early perioperative quality of recovery (QoR) in Vietnamese outpatients, focusing on a comparison of total and domain-specific QoR before and after surgery. Methods: This prospective observational study was conducted at the Day Surgery Unit, University Medical Center Ho Chi Minh City, Vietnam, from August to December 2024. Adult patients (≥ 18 years) scheduled for outpatient surgery who were able to communicate and provided written informed consent were consecutively recruited. Quality of recovery was assessed using the 15-item QoR-15 questionnaire across five domains preoperatively and 24 hours postoperatively. Recovery was classified as excellent, good, moderate, or poor. Pain intensity was measured with the Numerical Rating Scale (NRS). Paired tests compared pre- and postoperative outcomes. Results: Among 310 screened patients, 297 met the inclusion criteria and completed the study. Median QoR-15 scores declined from 145 to 139 (P < 0.001), approaching the minimal clinically important difference. Crucially, the overall QoR remained highly preserved, with 98.0% of patients achieving good or excellent recovery postoperatively, suggesting successful maintenance of high baseline function. Significant declines occurred in physical independence (19.8 to 17.2), physical comfort (49.4 to 47.1), pain (19.1 to 17.8), and psychological support (19.9 to 19.0; all P < 0.001). Paradoxically, the emotional state domain, which exhibited the largest proportional deficit preoperatively (9%), significantly improved postoperatively (36.4 to 37.4; deficit reduced to 6.0%; P < 0.001). The mean NRS pain increased from 0.9 to 3.3 (P < 0.001). Conclusions: In this prospective cohort of Vietnamese day-case surgery patients, postoperative early QoR showed a statistically significant decline compared with baseline, although most patients still achieved good or excellent recovery. Changes in recovery were mainly observed in physical independence and pain-related domains, while emotional state improved postoperatively. Educational level, type of anesthesia, type of surgery, and postoperative pain were identified as significant factors associated with postoperative QoR.