Group-based trajectory analysis of postoperative quality of recovery and outcomes after esophagectomy

BACKGROUND: Numerous guidelines for perioperative care in esophagectomy have been developed to promote postoperative quality of recovery (QoR). However, the trajectories and predictors of QoR based on patient-reported outcome after esophagectomy have not been characterized. METHODS: This multicenter, prospective, observational study enrolled 206 patients undergoing esophagectomy. Primary analysis was to estimate the trajectories of QoR using group-based trajectory modeling. RESULTS: Four distinct QoR trajectories were identified: poor QoR (38, 18.4%), poor to moderate QoR (83, 40.3%), moderate to good QoR (51, 24.8%), and good QoR (34, 16.5%). Secondary analysis revealed that preoperative nutritional risk (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.03-1.23), lower preoperative QoR-15 score (OR, 0.75; 95% CI, 0.61-0.91), longer duration of surgery (OR, 1.02; 95% CI, 1.01-1.04), and higher area under the curve of postoperative pain scores during coughing (OR, 1.22; 95% CI, 1.09-1.36) were significantly associated with the poor QoR trajectory. CONCLUSIONS: Notably, four postoperative QoR trajectories were identified and the predictors for poor QoR trajectory included preoperative nutritional risks, lower preoperative QoR-15 scores, longer surgical duration, and higher postoperative pain scores during coughing.