Quality of Recovery in Breast Surgery: Estimation of MCID and Effect of Anesthesia

Purpose: Postoperative recovery following breast surgery is essential for optimizing patient outcome. Despite the validation of the Quality of Recovery-15 (QOR-15) scale for the assessment of postoperative recovery, the threshold for clinically meaningful change over time is under-researched and under-reported for breast surgery. This study assesses the degree of postoperative recovery using QOR-15-derived MCID estimates for breast surgery patients. The data is derived from survey scores collected at multiple post-operative days. The study also evaluates patterns in the QOR categories (sub-domains): pain, physical comfort, physical independence, psychological support, and emotional state, and quantify the extent of change in patient recovery to potentially tailor intervention strategies for breast surgery patients. Methods : In a prospective cohort study, surveys from 60 breast surgery patients were utilized in the QOR-15 analyses. Data was collected at 4 postoperative time points: Post-operative days 1, 2, 3, and 7. The Minimal Clinically Important Difference (MCID) values were calculated for groups receiving pectoralis and serratus plane (PECS) block and subcutaneous infiltration of local anesthetic (LOC) agents. MCID was determined using both anchor-based and distribution-based methods that are triangulated. The sub-dimensions of QOR and the Cohen’s dz effect sizes were examined for the two anesthetic groups. A mixed-effects model was applied for statistical analysis. Results : A value of 3.8 to 9.9 MCID was determined from the QOR-15 score. This range was used as a metric for clinically important improvement in postoperative recovery among breast surgery patients. The sub-dimensional scores showed varying recovery patterns with the majority following steady and incremental trends. Effect size indicated small to moderate score gains with time. Preliminary findings suggest that anesthesia type may influence the early recovery profile. Conclusion : This study provides QOR-15- derived MCID values and a meaningful benchmark for evaluating postoperative recovery for breast surgery patients. It also highlights temporal patterns within the sub-dimensions of the QOR-15 survey. Additionally, the analysis of effect sizes and anesthesia types can enhance our understanding of postoperative recovery trajectories, serving as an input for the development of tailored perioperative pain management strategies for breast surgical patients.