PERIOPERATIVE FACTORS ASSOCIATED WITH EARLY POSTOPERATIVE RECOVERY AFTER UROLOGICAL PROCEDURES: A SINGLE-CENTER PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Early postoperative recovery after urological surgery may be influenced by patient characteristics, surgical factors, anesthetic technique, and perioperative care. This study assessed the association between selected perioperative factors and recovery outcomes during the first 24 hours after elective urological procedures. Methods: A single-center prospective observational study was conducted at the Institute of Kidney Diseases, Peshawar, from September 2025 to February 2026. Fifty adults undergoing elective urological procedures were included. Data were collected during the preoperative, intraoperative, and postoperative periods. The recorded variables included age, sex, body mass index, American Society of Anesthesiologists physical status, preoperative fasting duration, carbohydrate loading, surgical approach, procedure type, anesthetic technique, and opioid-sparing practice. Recovery outcomes included the Quality of Recovery-15 score, postoperative pain, postoperative nausea and vomiting, time to first solid food intake, time to first mobilization, and postoperative opioid requirement. Data were analyzed using IBM SPSS Statistics version 27. Nonparametric tests, correlation analysis, chi-square tests, and Fisher’s exact tests were applied according to the type of variable. Results: Among the 50 participants, 34 were male (68%) and 16 were female (32%). The mean age was 47.0 years, and the mean body mass index was (21.38 \pm 2.22\ \{kg/m^2}). Twenty-three participants (46%) had American Society of Anesthesiologists physical status I, and 27 (54%) had physical status II. Regional anesthesia was used in 37 participants (74%), whereas 13 (26%) received general anesthesia. Body mass index showed a statistically significant negative correlation with the total Quality of Recovery-15 score ((r=-0.381), (p=0.006)). American Society of Anesthesiologists physical status was significantly associated with time to first mobilization ((tau b=0.404), (p=0.001)), but not with Quality of Recovery-15 score, postoperative pain, or time to first solid food intake. Surgical approach was associated with time to first mobilization ((p<0.001), and post hoc analysis showed a significant difference between endoscopic and open approaches after Bonferroni adjustment. Procedure type was associated with time to first solid food intake ((p=0.003)) and time to first mobilization ((p<0.001)), but not with Quality of Recovery-15 score ((p=0.052)) or postoperative pain ((p=0.324)). Anesthesia type was associated with postoperative opioid requirement in the unadjusted analysis ((p<0.001)). No statistically significant association was reported between the examined variables and postoperative nausea and vomiting. Conclusion: Selected patient, surgical, and anesthetic factors were associated with specific early postoperative outcomes. Higher body mass index was associated with a lower Quality of Recovery-15 score, while surgical approach and procedure type were associated with early mobilization and oral intake. Anesthesia type was associated with postoperative opioid requirement. These findings should be interpreted as preliminary associations because the study was small, observational, and based on unadjusted analyses.