Document Type : Research Articles
Authors
1
Thoracic and Vascular Department, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
2
School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
3
Department of Health Management, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
4
Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
5
Department of Anesthesia, University Medical Center Ho Chi Minh City, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
6
Faculty of Health Management, Nguyen Tat Thanh University, Ho Chi Minh City, Viet Nam.
Abstract
Background: The Enhanced Recovery After Surgery (ERAS) protocol aims to achieve early recovery. However, its effects on the quality of recovery (QoR), as measured by patient-reported outcomes, still require further evaluation. This study aims to assess the QoR in patients undergoing lobectomy under ERAS protocol and identify the factors influencing QoR. Methods: A cross-sectional study was conducted using the QoR-15 score to measure QoR. The implementation of its twenty-seven components measured ERAS protocol adherence. Descriptive statistics were applied to describe the characteristics of QoR. Correlation and multivariable regression analyses assessed associations between ERAS adherence and QoR-15. Structural equation modeling (SEM) was used to evaluate whether potential factors mediated the ERAS adherence and QoR relationship via the average causal mediation effect (ACME). Results: This study included 98 patients. Their median QoR-15 score was 133, with an interquartile range of 130 to 134. QoR was excellent in 9.2%, good in 85.7%, and moderate in 5.1% of patients. The QoR-15 score moderately correlated with pain severity within the first 24 hours postoperatively (at POD0; ρ=−0.43, p<0.001) and ERAS adherence levels (ρ=0.31, p=0.002). Multivariable linear regression showed that pain at POD0 independently affected QoR-15 scores (β=−0.296, 95% confidence interval [CI] −0.407 to −0.184, p<0.001), while overall ERAS adherence did not (β=0.288, 95% CI −0.293 to 0.868, p=0.327). SEM analysis confirmed that higher ERAS adherence significantly reduced pain severity at POD0 (β = –0.47 per additional factor adhered to, p < 0.001), which in turn improved QoR-15 scores via a significant indirect effect (ACME = 0.381, p = 0.016). Conclusions: Patients undergoing lobectomy under the ERAS protocol generally report positive QoR experiences. Adherence to the ERAS protocol may indirectly enhance QoR by reducing early postoperative pain. The study shows favorable QoR outcomes with ERAS implementation and highlights the importance of protocol adherence.
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