Assessment of early cognitive recovery after surgery using the Post-operative Quality of Recovery Scale

Abstract

Background: Cognitive problems early after surgery are often considered transient in nature. Neuropsychological performance and its relation to other recovery parameters have rarely been systematically assessed during this period.

Methods: A subanalysis of the Post-operative Quality of Recovery Scale (PQRS) feasibility study included patients who completed the PQRS on day 3, and were categorised as recovered or not recovered in the cognitive domain using the revised scoring method.

Results: Of the 449 patients included in this paper, 388 (86.4%) recovered in the cognitive domain and 61 (13.6%) had not recovered at 3 days. Cognitive recovery in the early post-operative time points up to day 1 was significantly lower in patients who had not recovered at day 3 (P < 0.001). Of those not recovered on day 3, 59.1% had recovered on day 1, but lapsed to non-recovery on day 3. The non-recovered group demonstrated less recovery in the physiological (P = 0.019), activity of daily living (P = 0.049) and nociceptive (P = 0.033) domains, but no difference was found in the emotive domain. The non-recovered group had a higher incidence of major surgery (P = 0.021), a higher proportion of patients with difficulty eating (4.9% vs. 0.5%, P = 0.002 and a clinically unimportant but lower temperature (36.6° vs. 36.4°C, P = 0.010).

Conclusion: Failure of cognitive recovery is reasonably common 3 days after surgery, can fluctuate and is associated with poorer early recovery in the activities of daily living, nociceptive and physiological domains.