Patient preference for intraoperative opioid strategy and early postoperative recovery after noncardiac surgery: a prospective partially randomised patient-preference trial (the PERFECT trial)
7 affiliations
- 1Department of Anaesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- 2Department of Anaesthesiology and Perioperative Medicine, Nîmes University Hospital, Nîmes, France
- 3IMAGINE UR UM 103, Montpellier University, Anaesthesia Critical Care, Emergency and Pain Medicine Division, Nîmes University Hospital, Nîmes, France
- 4Department of Medicine Statistics Core, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- 5Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, Aberdeen, UK
- 6Anaesthesia Department, NHS Grampian, Aberdeen, UK
- 7Pain and Opioids After Surgery (PANDOS) European Society of Anaesthesiology and Intensive Care (ID ESAIC_RG_PAND) Research Group, Brussels, Belgium
Abstract
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.
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BibTeX
@article{gricourt2026patient,
title = {{Patient preference for intraoperative opioid strategy and early postoperative recovery after noncardiac surgery: a prospective partially randomised patient-preference trial (the PERFECT trial)}},
author = {Yann Gricourt and Nancy M. Boulos and Amelie Delaporte and Maziar M. Nourian and Daniel Pearce and Ido Neuman and Reza Borna and Josue Chirinos and Kenneth Lin and Justin Mitchell and Sebastian Kahf and Theodora Wingert and Tristan Grogan and David Boldt and Maxime Cannesson and Patrice Forget and Alexandre Joosten},
journal = {BJA Open},
year = {2026},
month = oct,
doi = {10.1016/j.bjao.2026.100867},
url = {https://doi.org/10.1016/j.bjao.2026.100867},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Patient preference for intraoperative opioid strategy and early postoperative recovery after noncardiac surgery: a prospective partially randomised patient-preference trial (the PERFECT trial)
AU - Yann Gricourt
AU - Nancy M. Boulos
AU - Amelie Delaporte
AU - Maziar M. Nourian
AU - Daniel Pearce
AU - Ido Neuman
AU - Reza Borna
AU - Josue Chirinos
AU - Kenneth Lin
AU - Justin Mitchell
AU - Sebastian Kahf
AU - Theodora Wingert
AU - Tristan Grogan
AU - David Boldt
AU - Maxime Cannesson
AU - Patrice Forget
AU - Alexandre Joosten
PY - 2026
DA - 2026/10/26
JO - BJA Open
DO - 10.1016/j.bjao.2026.100867
UR - https://doi.org/10.1016/j.bjao.2026.100867
AB - 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.
SN - 2772-6096
ER -