<![CDATA[Background: Suboptimal health-related quality of life (HRQoL) during postoperative recovery following lower extremity surgery increases healthcare costs and reduces patients’ overall well-being. However, evidence regarding factors influencing HRQoL trajectories remains limited.Objective: This study examined predictors of HRQoL and self-efficacy at weeks 1 and 4 post-discharge.Methods: This prospective cohort study used consecutive sampling to recruit 90 patients undergoing lower extremity orthopedic surgery (hip, femur, knee, or tibia) at a tertiary hospital in Thailand. Data collected included demographic characteristics, clinical factors, anthropometric measurements, and surgical variables. Outcomes were assessed at weeks 1 and 4 post-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 and self-efficacy.Results: Among 90 participants (mean age = 58.3 ± 12.4 years; 53.3% female), higher BMI independently predicted poorer physical HRQoL at week 1 (β = −0.54, p = .023) and week 4 (β = −0.62, p = .008). Waist circumference was an additional predictor of physical HRQoL at week 4 (β = 0.58, p = .002), with both variables explaining 34.6% of the variance (R² = .346, p < .001). Self-efficacy improved substantially from week 1 (109.14 ± 9.86) to week 4 (123.47 ± 0.64), with a mean difference of 14.33 points (95% CI [12.27, 16.39], Cohen’s d = 2.03, p < .001). In contrast, SF-12 Physical Component Scores remained unchanged (week 1: 28.21 ± 1.66; week 4: 28.11 ± 1.30, p = .571).Conclusions: Higher BMI was consistently associated with poorer postoperative physical HRQoL following lower extremity surgery, while physical HRQoL remained unchanged despite improvements in self-efficacy. Perioperative nurses should emphasize routine BMI assessment, targeted weight-management education, and support for patients’ self-efficacy during postoperative recovery. ]]>
