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)
Apinya Koontalay (Australia)
Khunphitha Junsevg (Department of Adult and Aging Nursing, Boromarajonani College of Nursing Nakhon Phanom, Nakhon Phanom University)
Arunrat Utaisang (Department of Adult and Aging Nursing, Boromarajonani College of Nursing Nakhon Phanom, Nakhon Phanom University)

Nurse Media Journal of Nursing
Vol 16, No 2 (2026): (August 2026) [In Progress]

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.