Factors Influencing Postoperative Recovery after Lower Extremity Surgery: A Prospective Cohort Study

Amornrat Sangsaikaew; Apinya Koontalay; Khunphitha Junsevg; Arunrat Utaisang

doi:10.14710/nmjn.v16i2.80772

DOI: https://doi.org/10.14710/nmjn.v16i2.80772

Factors Influencing Postoperative Recovery after Lower Extremity Surgery: A Prospective Cohort Study

*Amornrat Sangsaikaew - Department of Adult and Aging Nursing, Boromarajonani College of Nursing Nakhon Phanom, Nakhon Phanom University, Thailand

Apinya Koontalay - Australia, Australia

Khunphitha Junsevg - Department of Adult and Aging Nursing, Boromarajonani College of Nursing Nakhon Phanom, Nakhon Phanom University, Thailand

Arunrat Utaisang - Department of Adult and Aging Nursing, Boromarajonani College of Nursing Nakhon Phanom, Nakhon Phanom University, Thailand

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

BibTex Citation Data :

@article{NMJN80772,
    author = {Amornrat Sangsaikaew and Apinya Koontalay and Khunphitha Junsevg and Arunrat Utaisang},
    title = {Factors Influencing Postoperative Recovery after Lower Extremity Surgery: A Prospective Cohort Study},
    journal = {Nurse Media Journal of Nursing},
  volume = {16},
    number = {2},
    year = {2026},
    keywords = {Cohort study; health-related quality of life; lower extremity surgery; postoperative recovery; self-efficacy},
    abstract = {  Background:  Suboptimal health-related quality of life (HRQoL) during recovery from lower-extremity surgery can increase healthcare costs and reduce patients’ overall well-being. However, evidence regarding factors influencing HRQoL trajectories remains limited.   Purpose:  This study examined predictors of HRQoL and self-efficacy at weeks 1 and 4 after hospital discharge in patients undergoing lower-extremity orthopedic surgery.   Methods:  This prospective cohort study used consecutive sampling to recruit 90 patients undergoing lower-extremity orthopedic surgery (hip, femur, knee, tibia) at a tertiary hospital in Thailand. Collected data included demographic characteristics, clinical factors, anthropometric measurements (body mass index [BMI] and waist circumference), and surgical variables. Outcomes were assessed at weeks 1 and 4 after discharge using the 12-Item Short Form Health Survey (SF-12) to measure HRQoL and a validated 25-item questionnaire to measure self-efficacy. Multiple regression analysis was used to identify independent predictors of postoperative HRQoL, while paired-samples t-tests were used to examine changes in HRQoL and self-efficacy between weeks 1 and 4.   Results:  This study found that BMI independently predicted poorer physical-domain HRQoL at week 1 (β = -0.54,  p  = 0.023) and week 4 (β = -0.62,  p  = 0.008). Waist circumference emerged as an additional predictor of the physical domain of HRQoL at week 4 (β = -0.58,  p  = 0.002). The regression models explained 22.8% of the variance at week 1 (R² = 0.228,  p  < 0.001) and 21.8% at week 4 (R² = 0.218,  p  < 0.001). Self-efficacy improved substantially from week 1 to week 4 (MD = 14.33, SDD = 9.86, Cohen’s d = 2.03,  p  < 0.001). In contrast, the SF-12 physical component summary (PCS) scores remained unchanged (week 1: M = 28.21, SD = 1.66; week 4: M = 28.11, SD = 1.30; MD = -0.10, SDD = 1.35, Cohen’s d = 0.07,  p  = 0.571), revealing a marked dissociation between improved psychological confidence and stable outcomes in the physical domain of HRQoL.  Conclusion:  Elevated BMI consistently predicts poorer postoperative HRQoL following lower extremity surgery, with improvements in the physical domain of HRQoL often lagging behind improvements in patients’ self-efficacy. Perioperative nurses should emphasize routine BMI assessment and targeted weight-management education to bridge the gap between perceived self-efficacy and physical HRQoL outcomes in perioperative care protocols.},
   issn = {2406-8799},   pages = {347--358}  doi = {10.14710/nmjn.v16i2.80772},
    url = {https://ejournal.undip.ac.id/index.php/medianers/article/view/80772}
}

Citation Format:

Abstract

Background: Suboptimal health-related quality of life (HRQoL) during recovery from lower-extremity surgery can increase healthcare costs and reduce patients’ overall well-being. However, evidence regarding factors influencing HRQoL trajectories remains limited.

Purpose: This study examined predictors of HRQoL and self-efficacy at weeks 1 and 4 after hospital discharge in patients undergoing lower-extremity orthopedic surgery.

Methods: This prospective cohort study used consecutive sampling to recruit 90 patients undergoing lower-extremity orthopedic surgery (hip, femur, knee, tibia) at a tertiary hospital in Thailand. Collected data included demographic characteristics, clinical factors, anthropometric measurements (body mass index [BMI] and waist circumference), and surgical variables. Outcomes were assessed at weeks 1 and 4 after discharge using the 12-Item Short Form Health Survey (SF-12) to measure HRQoL and a validated 25-item questionnaire to measure self-efficacy. Multiple regression analysis was used to identify independent predictors of postoperative HRQoL, while paired-samples t-tests were used to examine changes in HRQoL and self-efficacy between weeks 1 and 4.

Results: This study found that BMI independently predicted poorer physical-domain HRQoL at week 1 (β = -0.54, p = 0.023) and week 4 (β = -0.62, p = 0.008). Waist circumference emerged as an additional predictor of the physical domain of HRQoL at week 4 (β = -0.58, p = 0.002). The regression models explained 22.8% of the variance at week 1 (R² = 0.228, p < 0.001) and 21.8% at week 4 (R² = 0.218, p < 0.001). Self-efficacy improved substantially from week 1 to week 4 (MD = 14.33, SDD = 9.86, Cohen’s d = 2.03, p < 0.001). In contrast, the SF-12 physical component summary (PCS) scores remained unchanged (week 1: M = 28.21, SD = 1.66; week 4: M = 28.11, SD = 1.30; MD = -0.10, SDD = 1.35, Cohen’s d = 0.07, p = 0.571), revealing a marked dissociation between improved psychological confidence and stable outcomes in the physical domain of HRQoL.

Conclusion: Elevated BMI consistently predicts poorer postoperative HRQoL following lower extremity surgery, with improvements in the physical domain of HRQoL often lagging behind improvements in patients’ self-efficacy. Perioperative nurses should emphasize routine BMI assessment and targeted weight-management education to bridge the gap between perceived self-efficacy and physical HRQoL outcomes in perioperative care protocols.

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Keywords: Cohort study; health-related quality of life; lower extremity surgery; postoperative recovery; self-efficacy

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Language : EN

In Vol 16, No 2 (2026): (August 2026) [In Progress]

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Factors Influencing Postoperative Recovery after Lower Extremity Surgery: A Prospective Cohort Study

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