Patient-reported outcome measures-guided perioperative care versus standard of care in postoperative recovery

OBJECTIVE: Patient-reported outcomes measures (PROMs) are widely used perioperative health status measurements for research and quality improvement. We hypothesised that PROMs could also be useful guiding individual perioperative care. DESIGN: Single centre prospective randomised open and pragmatic controlled trial. SETTING: Tertiary French University Hospital. PARTICIPANTS: Two hundred and eighty adult patients admitted for osteoarticular surgery. INTERVENTION: We conducted a randomised controlled trial comparing PROMs-guided perioperative care with usual care using the Quality of Recovery-15 (QoR-15) assessed on postoperative day (POD) 1, 3, 14 and 28. MAIN OUTCOME MEASURES: The primary endpoint was the change in the modified French version of the QoR-15 between the preoperative period and POD 35. The Minimal Clinically Important Difference (MCID) for the QoR-15 scale was six points. Secondary outcomes included persistent consumption of opioids at 5 weeks postoperatively. Data were analysed using Bayesian methods. RESULTS: The mean (95% credibility interval) difference in QoR-15 score between the preoperative, and POD 35 assessments was 5.5 (2.3 to 9.2) points higher in the experimental group compared with the control group, Pr(diff > 0) > 0.999. The probability that this difference is greater than the accepted MCID for the QoR-15 scale (6.0) was 39.4%. There is a 97.4% probability that the relative risk of persistent opioid consumption in the experimental group (12.3%) is less than 1 compared with the control group (21.2%). CONCLUSION: PROMs-guided postoperative care resulted in a nonclinically relevant increase in POD 35 health status measured by the QoR-15 scale and decreased persistent opioid consumption compared with standard of care. TRIAL REGISTRATION: NCT06182254, https://clinicaltrials.gov/study/NCT06182254.