Patient preference for intraoperative opioid strategy and early postoperative recovery after noncardiac surgery: a prospective partially randomised patient-preference trial (the PERFECT trial)

Background Patient-centred care increasingly encourages patients to participate in decisions regarding their anaesthetic management. However, whether expressing a preference regarding their anaesthetic management is associated with improved postoperative recovery remains unknown. We evaluated the association between preference expression and quality of recovery after noncardiac surgery. Methods In this prospective partially randomised patient-preference study conducted at two academic hospitals, adults undergoing minimally invasive abdominal, urologic, or gynaecologic surgery received standardised information on opioid-based and opioid-free anaesthesia, co-developed with patient partners. Participants expressing a preference received their preferred strategy, whereas those without a preference were randomised 1:1 to either strategy. The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 1. Results Among 220 analysed participants, 177 (80.5%) expressed a preference, and 43 (19.5%) underwent random allocation. Mean [standard deviation] QoR-15 scores on POD 1 were higher among participants expressing a preference than among randomised participants (108.8 [18.2] vs 100.8 [23.5]), with an unadjusted mean difference of 7.9 points (95% confidence interval [CI] 1.5–14.4; P =0.017). The adjusted marginal mean difference was 7.1 points (95% CI 0.3–13.9; P =0.042). Scores on the QoR-15 also remained higher on POD 2. Sensitivity analyses showed consistent effect estimates but attenuated statistical significance. Secondary outcomes, including postoperative nausea and vomiting and bradycardia, were similar between groups. Conclusions Expression of a preference regarding intraoperative opioid management was associated with better reported early postoperative patient-reported recovery. Given the non-randomised comparison and limited precision, -generating and support further investigation into the role of patient-preference expression in perioperative recovery. Trial registration The full, long-term study is pre-registered at ClinicalTrials.gov (identifier, NCT06855641; first posted, 3 March 2025; Alexandre Joosten). https://clinicaltrials.gov/study/NCT06855641.