| Characteristic | Overall (n = 237) |
|---|---|
| Age (years), Mediana (Q1–Q3) | 52.0 (37.0–63.0) |
| Body mass index (kg/m²), Mediana (Q1–Q3) | 27.6 (23.7–32.2) |
| Preoperative fasting time (hours), Mediana (Q1–Q3) | 14.0 (11.0–17.0) |
| Time from surgery to QoR-15 assessment (hours), Mediana (Q1–Q3) | 17.0 (14.0–20.0) |
| Any pre-existing comorbidity, n (%) | 152 (64.1%) |
| Endocrine or metabolic disease, n (%) | 128 (54.0%) |
| Hypertension, n (%) | 96 (40.5%) |
| Cardiovascular disease, n (%) | 89 (37.6%) |
| Obesity (BMI ≥30 kg/m²), n (%) | 78 (32.9%) |
| Obesity and surgical profile, n (%) | |
| Non-obese (non-bariatric surgery) | 159 (67.1%) |
| Obese (non-bariatric surgery) | 55 (23.2%) |
| Bariatric surgery (obese) | 23 (9.7%) |
| Diabetes mellitus, n (%) | 61 (25.7%) |
| Psychiatric disorders, n (%) | 47 (19.8%) |
| Dyslipidemia, n (%) | 34 (14.3%) |
| Gastrointestinal disease, n (%) | 16 (6.8%) |
| Polypharmacy (≥5 chronic medications), n (%) | 39 (16.5%) |
| Ambulated before assessment, n (%) | 180 (75.9%) |
| Resumed oral intake before assessment, n (%) | 187 (78.9%) |
Qualidade da Recuperação Pós-Operatória Após Cirurgias Eletivas (QoR-15)
Reanálise Estatística Completa e Tabelas para Publicação (Resposta ao Parecer Editorial)
1 Baseline Demographic, Clinical, and Perioperative Characteristics
2 Postoperative Quality of Recovery (Overall, Severity Categories, Domains, and Items)
| QoR-15 Parameter | Median (IQR) or n (%) |
|---|---|
| Total QoR-15 score (0–150), Mediana (Q1–Q3) | 137 (128–145) |
| Recovery severity classification, n (%) | |
| Excellent (136–150) | 127 (53.6%) |
| Good (122–135) | 71 (30.0%) |
| Moderate (90–121) | 34 (14.3%) |
| Poor (<90) | 5 (2.1%) |
| Domain: Physical comfort (0–50), Mediana (Q1–Q3) | 45 (41–48) |
| Domain: Physical independence (0–20), Mediana (Q1–Q3) | 20 (18–20) |
| Domain: Psychological support (0–20), Mediana (Q1–Q3) | 20 (16–20) |
| Domain: Emotional state (0–40), Mediana (Q1–Q3) | 40 (36–40) |
| Domain: Pain (0–20), Mediana (Q1–Q3) | 20 (13–20) |
| Item 1: Able to breathe easily, Mediana (Q1–Q3) | 10 (10–10) |
| Item 2: Been able to enjoy food, Mediana (Q1–Q3) | 10 (10–10) |
| Item 3: Feeling rested, Mediana (Q1–Q3) | 9 (7–10) |
| Item 4: Have had a good sleep, Mediana (Q1–Q3) | 10 (10–10) |
| Item 5: Able to look after personal hygiene unaided, Mediana (Q1–Q3) | 10 (9–10) |
| Item 6: Able to communicate with family or friends, Mediana (Q1–Q3) | 10 (8–10) |
| Item 7: Getting support from hospital doctors and nurses, Mediana (Q1–Q3) | 10 (8–10) |
| Item 8: Able to return to work or usual home activities, Mediana (Q1–Q3) | 10 (10–10) |
| Item 9: Feeling comfortable and in control, Mediana (Q1–Q3) | 10 (10–10) |
| Item 10: Having a feeling of general well-being, Mediana (Q1–Q3) | 10 (10–10) |
| Item 11: Moderate pain (reverse scored), Mediana (Q1–Q3) | 10 (5–10) |
| Item 12: Severe pain (reverse scored), Mediana (Q1–Q3) | 10 (10–10) |
| Item 13: Nausea or vomiting (reverse scored), Mediana (Q1–Q3) | 9 (5–10) |
| Item 14: Feeling worried or anxious (reverse scored), Mediana (Q1–Q3) | 10 (10–10) |
| Item 15: Feeling sad or depressed (reverse scored), Mediana (Q1–Q3) | 10 (10–10) |
3 (Revised): Unadjusted and Multivariable Continuous & Sensitivity Analyses
This section directly addresses the two main methodological points raised by the journal:Continuous QoR-15 modeling: Models 1 and 2 treat the QoR-15 score as a continuous outcome via Median Quantile Regression (\(\beta_{\text{median}}\)) and Multiple Linear Regression with HC3 Robust Standard Errors (\(\beta_{\text{mean}}\)).Separation of Obesity and Bariatric Surgery: The 3-level exposure variable demonstrates that obesity in non-bariatric procedures is not associated with worse recovery (\(p = 0.434\)), whereas bariatric surgery (\(\beta_{\text{median}} = -15.0\text{ points}, p < 0.001\)) and psychiatric disorders (\(\beta_{\text{median}} = -6.0\text{ points}, p = 0.029\)) are independently associated with lower postoperative QoR-15 scores.
3.1 Unadjusted Bivariate Comparisons
| Unadjusted Bivariate Comparisons of QoR-15 Scores | |||||
| Mann-Whitney U test (2 groups) or Kruskal-Wallis test (3 groups) | |||||
| Variavel | Categoria | n | Median (IQR) | Mean ± SD | p-value |
|---|---|---|---|---|---|
| grupo_ob_bar | Non-obese (non-bariatric surgery) | 159 | 139.0 (130.0–145.0) | 135.4 ± 14.5 | 0.0002 |
| grupo_ob_bar | Obese (non-bariatric surgery) | 55 | 135.0 (129.0–142.0) | 133.9 ± 13.1 | |
| grupo_ob_bar | Bariatric surgery (obese) | 23 | 124.0 (105.0–135.5) | 119.8 ± 19.2 | |
| obesidade | No | 159 | 139.0 (130.0–145.0) | 135.4 ± 14.5 | 0.0049 |
| obesidade | Yes | 78 | 134.0 (123.2–140.0) | 129.8 ± 16.4 | |
| psiquiatrico | No | 190 | 138.0 (130.0–145.0) | 135.0 ± 15.0 | 0.0008 |
| psiquiatrico | Yes | 47 | 133.0 (118.5–139.5) | 127.6 ± 15.3 | |
| polifarmacia | No | 198 | 138.0 (130.0–145.0) | 134.5 ± 15.1 | 0.0300 |
| polifarmacia | Yes | 39 | 132.0 (121.5–141.0) | 129.0 ± 16.1 | |
| endocrino | No | 109 | 140.0 (130.0–145.0) | 135.4 ± 15.7 | 0.0229 |
| endocrino | Yes | 128 | 135.0 (124.0–142.2) | 132.0 ± 14.9 | |
| has | No | 141 | 139.0 (129.0–145.0) | 134.5 ± 15.7 | 0.1220 |
| has | Yes | 96 | 134.0 (124.0–142.2) | 132.2 ± 14.8 | |
| dm | No | 176 | 137.5 (128.0–145.0) | 133.4 ± 16.3 | 0.6818 |
| dm | Yes | 61 | 135.0 (129.0–144.0) | 134.1 ± 12.3 | |
| cardio | No | 148 | 138.0 (128.0–145.0) | 134.1 ± 16.3 | 0.1908 |
| cardio | Yes | 89 | 134.0 (126.0–142.0) | 132.7 ± 13.7 | |
| dislipidemia | No | 203 | 137.0 (129.0–145.0) | 133.7 ± 15.7 | 0.4062 |
| dislipidemia | Yes | 34 | 134.5 (123.2–141.5) | 132.7 ± 13.0 | |
| gastro | No | 221 | 137.0 (129.0–145.0) | 133.9 ± 15.2 | 0.1994 |
| gastro | Yes | 16 | 122.0 (119.0–148.5) | 128.7 ± 16.7 | |
| idade_cat | ≤52 years | 120 | 135.5 (124.0–143.0) | 132.1 ± 15.5 | 0.1001 |
| idade_cat | >52 years | 117 | 138.0 (130.0–145.0) | 135.0 ± 15.1 | |
3.2 Multivariable Continuous Models & Non-Bariatric Sensitivity Analysis
| Características |
Model 1: Quantile Regression (n = 237)
|
Model 2: Robust Linear Regression (n = 237)
|
||
|---|---|---|---|---|
| β_median | Valor-p | β_mean (HC3) | Valor-p | |
| Obesity & Surgical Profile | ||||
| Non-obese (non-bariatric surgery) | — | — | ||
| Obese (non-bariatric surgery) | -2.0 (-9.2 to 5.2) | 0,59 | -0.71 (-4.9 to 3.4) | 0,74 |
| Bariatric surgery (obese) | -15 (-25 to -4.6) | 0,005 | -14 (-23 to -5.4) | 0,002 |
| Psychiatric disorders | ||||
| No | — | — | ||
| Yes | -6.0 (-14 to 1.7) | 0,13 | -5.5 (-11 to -0.45) | 0,033 |
| Polypharmacy (≥5 medications) | ||||
| No | — | — | ||
| Yes | -4.0 (-12 to 4.3) | 0,34 | -2.6 (-7.9 to 2.7) | 0,33 |
| Abreviação: IC = Intervalo de Confiança | ||||
| Características |
Sensitivity Quantile Reg. (n = 214)
|
Sensitivity Robust OLS (n = 214)
|
||
|---|---|---|---|---|
| β_median | Valor-p | β_mean (HC3) | Valor-p | |
| Obesity (BMI ≥30 kg/m²) | ||||
| No | — | — | ||
| Yes | -2.0 (-9.3 to 5.3) | 0,59 | -0.58 (-4.8 to 3.6) | 0,78 |
| Psychiatric disorders | ||||
| No | — | — | ||
| Yes | -7.0 (-15 to 1.4) | 0,10 | -7.2 (-12 to -2.0) | 0,007 |
| Polypharmacy (≥5 medications) | ||||
| No | — | — | ||
| Yes | -4.0 (-13 to 5.1) | 0,38 | -2.3 (-7.6 to 3.0) | 0,39 |
| Abreviação: IC = Intervalo de Confiança | ||||
3.3 Supplementary Model Using the Clinically Validated Cutoff (\(\text{QoR-15} < 122\))
| Características | OR (95% CI) | Valor-p |
|---|---|---|
| Obesity & Surgical Profile | ||
| Non-obese (non-bariatric surgery) | — | |
| Obese (non-bariatric surgery) | 0.96 (0.37 to 2.30) | 0,93 |
| Bariatric surgery (obese) | 4.16 (1.53 to 11.1) | 0,004 |
| Psychiatric disorders | ||
| No | — | |
| Yes | 2.76 (1.22 to 6.12) | 0,013 |
| Polypharmacy (≥5 medications) | ||
| No | — | |
| Yes | 1.33 (0.51 to 3.20) | 0,54 |
| Abreviações: IC = Intervalo de Confiança, OR = Razão de chances | ||
4 QoR-15 Scores by Surgical Specialty (Pooling Small Subgroups)
To address the editorial concern regarding small sample sizes in certain surgical specialties, specialties with fewer than 13 patients are pooled into “Other specialties (n < 13)” to preserve statistical power during omnibus and post-hoc comparisons.
| Table 4. Postoperative QoR-15 Scores Across Surgical Specialties | ||||
| Omnibus Kruskal-Wallis test: chi-squared = 25.91, p = 0.0021 | ||||
| Surgical Specialty | n | Median (IQR) | Mean ± SD | Min–Max |
|---|---|---|---|---|
| Urology (Code 4) | 50 | 139.5 (130.0–145.0) | 136.2 ± 13.6 | 80–150 |
| General Surgery (Code 1) | 31 | 140.0 (125.0–148.5) | 136.8 ± 11.4 | 119–150 |
| Other specialties (n < 13) | 27 | 134.0 (125.0–140.0) | 128.8 ± 20.9 | 48–150 |
| Otorhinolaryngology (Code 6) | 25 | 140.0 (132.0–146.0) | 137.0 ± 11.2 | 107–148 |
| Bariatric Surgery (Code 2) | 23 | 124.0 (105.0–135.5) | 119.8 ± 19.2 | 74–148 |
| Digestive Surgery (Code 3) | 21 | 136.0 (120.0–143.0) | 130.0 ± 17.9 | 87–150 |
| Thoracic / Head & Neck (Code 5) | 17 | 134.0 (128.0–140.0) | 132.1 ± 12.6 | 102–148 |
| Vascular Surgery (Code 9) | 17 | 138.0 (130.0–145.0) | 137.4 ± 10.4 | 120–150 |
| Colorectal Surgery (Code 11) | 13 | 143.0 (135.0–148.0) | 139.5 ± 10.9 | 114–150 |
| Plastic / Maxillofacial (Code 8) | 13 | 139.0 (136.0–146.0) | 140.0 ± 7.1 | 125–150 |
5 Domain- and Item-Specific Comparison (Bariatric Surgery vs. Other Specialties)
| Características | Other specialties N = 214 |
Bariatric surgery N = 23 |
Valor-p1 |
|---|---|---|---|
| Total QoR-15 score (0–150), Mediana (Q1–Q3) | 138.0 (130.0–145.0) | 124.0 (104.0–136.0) | <0,001 |
| Domain 1: Physical comfort (0–50), Mediana (Q1–Q3) | 45.0 (41.0–49.0) | 41.0 (39.0–44.0) | 0,002 |
| Domain 2: Physical independence (0–20), Mediana (Q1–Q3) | 20.0 (18.0–20.0) | 18.0 (13.0–20.0) | <0,001 |
| Domain 3: Psychological support (0–20), Mediana (Q1–Q3) | 20.0 (18.0–20.0) | 13.0 (10.0–18.0) | <0,001 |
| Domain 4: Emotional state (0–40), Mediana (Q1–Q3) | 40.0 (37.0–40.0) | 36.0 (30.0–40.0) | 0,002 |
| Domain 5: Pain (0–20), Mediana (Q1–Q3) | 20.0 (13.0–20.0) | 15.0 (13.0–20.0) | 0,092 |
| Item 1: Able to breathe easily, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (9.0–10.0) | 0,22 |
| Item 2: Been able to enjoy food, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (10.0–10.0) | 0,11 |
| Item 3: Feeling rested, Mediana (Q1–Q3) | 10.0 (7.0–10.0) | 8.0 (6.0–10.0) | 0,10 |
| Item 4: Have had a good sleep, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (10.0–10.0) | >0,99 |
| Item 5: Personal toilet and hygiene unaided, Mediana (Q1–Q3) | 10.0 (9.0–10.0) | 10.0 (8.0–10.0) | 0,076 |
| Item 6: Communicate with family or friends, Mediana (Q1–Q3) | 10.0 (9.0–10.0) | 10.0 (6.0–10.0) | 0,027 |
| Item 7: Support from hospital doctors and nurses, Mediana (Q1–Q3) | 10.0 (9.0–10.0) | 6.0 (0.0–10.0) | <0,001 |
| Item 8: Return to work or usual home activities, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (5.0–10.0) | <0,001 |
| Item 9: Feeling comfortable and in control, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (7.0–10.0) | <0,001 |
| Item 10: Feeling of general well-being, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (10.0–10.0) | 0,91 |
| Item 11: Moderate pain, Mediana (Q1–Q3) | 10.0 (5.0–10.0) | 8.0 (3.0–10.0) | 0,16 |
| Item 12: Severe pain, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (10.0–10.0) | 0,57 |
| Item 13: Nausea or vomiting, Mediana (Q1–Q3) | 10.0 (5.0–10.0) | 5.0 (2.0–8.0) | <0,001 |
| Item 14: Feeling worried or anxious, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (5.0–10.0) | 0,005 |
| Item 15: Feeling sad or depressed, Mediana (Q1–Q3) | 10.0 (10.0–10.0) | 10.0 (6.0–10.0) | 0,083 |
| 1 Teste de soma de postos de Wilcoxon | |||