Routine Anaesthesia Ward-Based Patient Visits in Surgery: 1-Year Outcomes of the TRACE Randomized Clinical Trial

Anesthesiology Medicine
anaesthesia ward visits surgical outcomes functional recovery quality of life randomized clinical trial

In perioperative medicine, the long-term clinical and functional recovery of postoperative patients has always been a focus of research. Traditionally, postoperative complications, mortality, readmission rates, and reoperation rates have been the primary indicators for measuring surgical patient outcomes. However, as medical research deepens, an increasing number of studies are beginning to focus on patient-centered outcomes, such as patient-reported quality of life (QoL). Despite this, long-term follow-up studies targeting the general surgical population remain scarce, and most research is concentrated on specific surgical patient groups, limiting the generalizability of the results.

To address this research gap, a Dutch research team conducted the TRACE (Routine Postsurgical Anaesthesia Visit to Improve Patient Outcome) randomized clinical trial, aiming to evaluate the impact of routine postoperative visits by anesthesiologists on long-term patient outcomes. The short-term results (30 days) of the study have already been published, showing no significant improvement in postoperative complications and mortality from anesthesiologist visits. Therefore, the research team further explored the effects of this intervention on clinical outcomes, functional recovery, and quality of life one year after surgery.

Source of the Paper

This paper was authored by Valérie M. Smit-Fun et al., with the research team hailing from multiple medical institutions in the Netherlands, including Maastricht University Medical Centre+, Amsterdam University Medical Centre, Albert Schweitzer Hospital, and University Medical Centre Utrecht. The paper was published in 2025 in the British Journal of Surgery (BJS), with the DOI 10.1093/bjs/znaf019.

Study Process

Study Design

The TRACE study is a prospective, multicenter, stepped-wedge, cluster-randomized interventional trial involving patients undergoing non-cardiac surgery in nine hospitals in the Netherlands. The study employed a stepped-wedge randomization design, dividing eligible patients into a control group and an intervention group. The control group received standard postoperative care, while the intervention group received additional routine visits by an anesthesiologist on postoperative days 1 and 3. The purpose of these visits was to promptly identify patient deterioration and avoid complications and failure to rescue.

Study Participants

The study included 5,473 adult patients undergoing elective non-cardiac surgery who were at risk for adverse postoperative outcomes. Patients had to meet one of the following criteria: age ≥60 years; age ≥45 years with a Revised Cardiac Risk Index (RCRI) >2; age ≥18 years with an indication for postoperative invasive pain therapy; or age ≥18 years with a postoperative Surgical Apgar Score (SAS) <5. Patients requiring postoperative ICU stays were excluded.

Data Collection

The primary clinical outcome measures included 1-year mortality, readmission rates, and reoperation rates. Functional recovery (FR) was assessed using patient-reported instruments: the Global Surgical Recovery Index (GSR), the ability to perform Activities of Daily Living (ADL), and the Functional Recovery Index (FRI). Quality of life was measured using the EQ-5D-5L questionnaire.

Statistical Analysis

Data analysis employed mixed-effects regression models to compare differences between the control and intervention groups. All analyses were performed based on the intention-to-treat principle.

Main Results

Clinical Outcomes

During the 1-year follow-up, mortality rates were 5.4% in the control group and 5.8% in the intervention group, readmission rates were 27% and 26%, respectively, and reoperation rates were 20% and 18%, respectively. No significant differences were observed between the two groups in clinical outcome measures.

Functional Recovery

In terms of functional recovery, both groups’ GSR index, ADL ability, and FRI scores returned to preoperative levels at 1 year post-surgery. However, 30% of patients were still unable to fully perform daily activities, and 40%-51% of patients reported problems in the EQ-5D-5L dimensions of mobility, usual activities, and pain/discomfort.

Quality of Life

The EQ-5D-5L index and Visual Analogue Scale (VAS) showed that both groups’ quality of life returned to preoperative levels at 1 year post-surgery, but a significant proportion of patients still reported health-related limitations in daily life.

Conclusion

The study results indicate that routine postoperative visits by anesthesiologists did not significantly improve patients’ clinical outcomes, functional recovery, or quality of life. Although most patients’ health metrics returned to preoperative levels at 1 year post-surgery, a considerable proportion still faced challenges in daily life and health-related quality of life. This finding suggests that while short-term mortality has improved, long-term outcomes have not significantly improved, and there remains room for enhancing postoperative functional recovery and quality of life.

Highlights of the Study

  1. Long-Term Follow-Up: The study provides 1-year follow-up data, filling a gap in long-term research in perioperative medicine.
  2. Multidimensional Assessment: The study not only focuses on traditional clinical outcomes but also includes assessments of functional recovery and quality of life, offering a more comprehensive understanding of patient outcomes.
  3. Stepped-Wedge Randomization Design: The study employs a stepped-wedge randomization design, enhancing internal validity and external generalizability.

Significance of the Study

The findings of the TRACE study hold significant implications for clinical practice. First, the study suggests that routine postoperative visits by anesthesiologists do not significantly improve long-term patient outcomes, providing critical evidence for clinical decision-making. Second, the study highlights the potential for improving postoperative functional recovery and quality of life, indicating that future research should focus on more effective interventions to further enhance long-term outcomes. Additionally, the study results can be used for patient education, helping patients and physicians better set expectations for postoperative recovery.

The TRACE study provides valuable long-term follow-up data for perioperative medicine, offering important references for future research and clinical practice.