Influencing factors of the quality of postoperative rehabilitation of patients after cardiac large vessels surgery and establishment of prediction model

Objective To evaluate the quality of postoperative recovery of patients undergoing cardiac great vessels surgery by 15-item Recovery Quality Score Scale (QoR-15), to retrospectively analyze the influence of perioperative multi-factors on postoperative recovery quality, and to establish the predictive model.

Methods Clinical data of patients who underwent cardiac great vascularsurgery from March 2020 to September 2022 were collected through electronic medical record system and the postoperative QoR-15 score were evaluated. The data including gender, age, postoperative follow-up time, American Society of Anesthesiologists (ASA) classification, preoperative lactate level, comorbidities, emergency or not, extracorporeal circulation or not, etc. were collected. The modified frailty index (mFI) was also calculated. Surgical patterns, operation time, extracorporeal circulation time, aortic block time, type of heart recurrence, perioperative fluid therapy, extracorporeal circulation temperature, and other postoperative data as well as postoperative data including ICU retention time after surgery, total length of stay and QoR-15 score were recorded. The univariate and multivariate Logistic regression analysis were then applied to construct a prediction model, and its accuracy was validated.

Results A total of 213 patients were included, in which 15 patients were excluded, and 198 postoperative QoR-15 score sheets were received. Gender, ASA classification, preoperative lactate level, postoperative follow-up time, and mFI were significant influencing factors on the quality of rehabilitation of patients undergoing cardiac or great vascular surgery. The prediction model of ln(p/1-p)=-5.571+0.862×gender+3.844×ASA classification+3.143×preoperative lactate level+2.001×postoperative follow-up time+3.712×mFI, which had good predictive and classification effects.

Conclusion Gender, ASA classification, preoperative lactate level, postoperative follow-up time and mFI are influencing factors on the recovery quality of patients after cardiac great vascular surgery.