Quality of recovery and pre-existing impaired cognition in patients undergoing advanced GI endoscopic procedures with patient-controlled sedation: a prospective observational cohort study

TL;DR

This study examines how well patients recover after advanced GI endoscopic procedures and finds that one-third do not recover well, even with patient-controlled sedation.

Contribution

The study is one of the first to evaluate quality of recovery and the role of pre-existing cognitive impairment in patients undergoing advanced GI endoscopy.

Findings

Most patients showed improved recovery scores by day 1 post-procedure.

One-third of patients experienced a lack of recovery or worsening scores.

Pre-procedural cognitive impairment was common but not independently linked to poor recovery.

Abstract

Advanced GI endoscopy (GIE) procedures are common, and many patients undergoing these procedures are elderly with comorbidities. The procedures are commonly conducted in day surgery, and good postprocedural recovery is assumed. How patients recover has been poorly studied, however. The primary aim of this study was to describe the quality of recovery (QoR) in patients undergoing advanced GIE procedures with patient-controlled sedation. A secondary aim was to evaluate if impaired preprocedural cognitive ability was an independent risk for lack of recovery.

Measurements were conducted by using the 15-item QoR instrument (QoR-15) before the GIE procedure (baseline) and on days 1 and 5 postprocedure. Postprocedural recovery scores were compared versus baseline scores. Lack of recovery was defined as any decrease in the QoR-15 score compared with baseline. Cognitive ability was assessed by using the clock-in-the-box test. A multivariable logistic regression analysis was used to test the independent association between preprocedural cognitive impairment and lack of recovery.

A total of 93 patients were included in the study. The QoR-15 score significantly improved at postprocedure day 1 (P = .001) with no further improvement at day 5. One-third of the patients did not recover and even had negative trajectories. Preprocedural impaired cognitive ability was present in 41% of patients but could not independently explain the negative changes in the QoR-15 score.

QoR significantly improved for a majority of patients by day 1 after advanced GIE procedures. However, one-third of patients displayed a lack of recovery. We highlight the need for improved strategies to increase quality of postendoscopic recovery and the recognition of preoperative cognitive impairment.

Figures