Incidence and risk factors for lack of recovery in patients undergoing major abdominal noncardiac surgery in Sweden: a prospective observational study

Background Patients' experiences of postoperative recovery provide insights beyond traditional outcomes. Postoperative complications impair recovery, prolong hospital stay, and affect well-being. Long-term data on recovery patterns, particularly regarding complications, are scarce but essential for guiding perioperative care. Methods A pre-planned nested cohort study within the Myocardial Injury in Non-Cardiac Surgery in Sweden study was conducted at two Swedish hospitals; 124 adult patients undergoing major noncardiac surgery were followed for up to 1 yr. Lack of recovery was defined as a ≥6-point decrease in Quality of Recovery-15 (QoR-15) score from preoperative baseline. We assessed the incidence and risk factors, described the course of recovery, and examined the association between early lack of recovery and days alive and out of hospital (DAOH) at 30 days after surgery. Results Lack of recovery was reported by 58%, 46%, and 24% of patients at 7–10 days, 30 days, and 1 yr, respectively. Complications occurred in 49% and were associated with a two-fold increase in the odds of lack of recovery at 30 days (adjusted odds ratio 2.60 [1.18–5.73]; P =0.018), independent of age, ASA physical classification score, and sex. Patients with complications reported lower QoR-15 scores and a slower recovery over time. Early lack of recovery was associated with 3.7 fewer days alive and out of hospital (mean difference −3.69 [−6.54 to −0.83]; P =0.012). Conclusions Half of the study group reported a lack of recovery at 1 week, with persistence at 1 month. Complications were common and strongly associated with lack of recovery. Although recovery is slower in patients with complications, most regain or exceed baseline levels by 1 year. Early lack of recovery was linked to reduced days alive and out of hospital.