European Journal of Cardiovascular Medicine

Recovery following general anaesthesia is a dynamic physiological process characterized by the restoration of consciousness, protective airway reflexes, cardiorespiratory stability, effective pain control, and the absence of significant postoperative complications. During the immediate postoperative period, residual effects of anaesthetic agents may predispose patients to respiratory compromise, haemodynamic instability, postoperative pain, nausea, vomiting, and delayed awakening, making accurate assessment of recovery essential for ensuring patient safety and facilitating timely discharge from the post-anaesthesia care unit (PACU) [1].

Advances in anaesthetic techniques, minimally invasive surgical procedures, and enhanced recovery protocols have substantially improved perioperative outcomes. Laparoscopic surgery has become the preferred approach for many elective surgical procedures because it is associated with reduced postoperative pain, smaller incisions, shorter hospital stay, and earlier recovery. Nevertheless, patients undergoing laparoscopic procedures under general anaesthesia remain susceptible to postoperative complications, including haemodynamic fluctuations, respiratory depression, shoulder-tip pain, postoperative nausea and vomiting (PONV), and delayed recovery. In addition, pneumoperitoneum and patient positioning during laparoscopy may further influence postoperative physiological recovery, highlighting the importance of reliable recovery assessment tools [2].

The Modified Aldrete Score (MAS), introduced by Aldrete and Kroulik in 1970, is one of the most widely used scoring systems for evaluating readiness for discharge from the PACU. The score assesses five physiological parameters—activity, respiration, circulation, consciousness, and oxygen saturation—with a maximum score of 10. Patients achieving a score of 9 or above are generally considered fit for transfer from Phase I recovery. Despite its widespread acceptance, the MAS primarily evaluates physiological recovery and does not incorporate important postoperative variables such as pain and PONV, both of which significantly influence patient comfort, recovery quality, and discharge readiness [2–4].

To overcome these limitations, White and Song proposed the Fast Track Criteria (FTC), a more comprehensive recovery assessment tool that includes postoperative pain and PONV in addition to consciousness, haemodynamic stability, respiratory function, motor activity, and oxygen saturation. Patients with a total score of 12 or more are considered suitable for fast-tracking, allowing selected patients to bypass the PACU and proceed directly to Phase II recovery. Previous studies have suggested that FTC may provide a more clinically relevant assessment of postoperative recovery and reduce unnecessary PACU stay while maintaining patient safety [5–7].

Although several studies have compared MAS and FTC in ambulatory surgical settings, evidence regarding their comparative performance following laparoscopic procedures remains limited, particularly in the Indian population. Therefore, the present study was undertaken to compare the Modified Aldrete Score and Fast Track Criteria in patients undergoing laparoscopic surgeries under general anaesthesia and to evaluate their usefulness in assessing postoperative recovery and readiness for discharge from the PACU.

months from the date of approval by the Institutional Ethics Committee, including patient recruitment, data collection, and analysis.

Study Design:

Comparative observational study.

Place of Study:

Department of Anaesthesiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim.

Study Population:

Adult patients undergoing elective laparoscopic surgical procedures under general anaesthesia at Sikkim Manipal Institute of Medical Sciences.

Sample Size:

A total of 200 patients.

• Fast Track Criteria (FTC) Group: 100 patients
• Modified Aldrete Score (MAS) Group: 100 patients

Inclusion Criteria:

1. Patients aged 18–65 years.
2. Patients of either gender.
3. Patients belonging to American Society of Anesthesiologists (ASA) physical status I and II.
4. Patients scheduled for elective laparoscopic surgical procedures under general anaesthesia.
5. Patients willing to participate and providing written informed consent.

Exclusion Criteria:

1. Patients younger than 18 years or older than 65 years.
2. ASA physical status III or IV.
3. Patients undergoing emergency laparoscopic surgery.
4. Patients with significant cardiovascular, respiratory, hepatic, renal, or neurological diseases affecting postoperative recovery.
5. Patients with psychiatric illness or cognitive impairment interfering with postoperative assessment.
6. Patients requiring postoperative mechanical ventilation or admission to the intensive care unit.
7. Patients with known allergy or contraindication to the anaesthetic drugs used in the study.
8. Patients who refuse to participate or are unable to provide informed consent.

Statistical Analysis:

For statistical analysis, data were entered into a Microsoft Excel spreadsheet and analyzed using SPSS version 27.0 and GraphPad Prism version 5. Continuous variables were expressed as mean ± standard deviation (SD), whereas categorical variables were presented as frequency (n) and percentage (%). The normality of continuous variables was assessed using the Shapiro–Wilk test. Comparisons of continuous variables between the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups, including anthropometric measurements, perioperative haemodynamic parameters (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, and oxygen saturation), duration of surgery, recovery time, and postoperative recovery scores, were performed using the independent Student's t-test. Comparisons of categorical variables, including age group, gender, ASA physical status, diagnosis, type of surgery, and comorbidities, were carried out using the Chi-square test or Fisher's exact test, wherever appropriate. All statistical tests were two-tailed, and a p-value <0.05 was considered statistically significant.

Table 1: Baseline Demographic and Clinical Characteristics of the Study Participants

Table 2: Comparison of Clinical Characteristics Between the FTC and MAS Groups

Table 3: Comparison of Intraoperative Hemodynamic Parameters Between the Study Groups

Table 4: Comparison of Intraoperative Duration and Postoperative Recovery Time Between the Study Groups

Table 5: Comparison of Scores Between the FTC and MAS Groups

The baseline demographic and clinical characteristics were comparable between the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups. The age distribution did not differ significantly, with patients aged ≤35 years comprising 39% in the FTC group and 45% in the MAS group, those aged 36–50 years accounting for 45% and 42%, and those aged >51 years representing 16% and 13%, respectively (p = 0.784). Gender distribution was also similar, with males constituting 27% of the FTC group and 29% of the MAS group, while females accounted for 73% and 71%, respectively (p = 0.755). The distribution of ASA physical status was comparable between the groups, with ASA I observed in 60% of FTC patients and 56% of MAS patients, and ASA II in 40% and 44%, respectively (p = 0.761). Furthermore, there were no significant differences in mean body weight (62.7 ± 9.5 vs. 63.5 ± 11.5 kg; p = 0.706), mean height (1.5 ± 0.2 vs. 1.6 ± 0.1 m; p = 0.619), or mean BMI (26.9 ± 6.1 vs. 26.3 ± 5.2 kg/m²; p = 0.773). These findings indicate that the two groups were well matched with respect to baseline demographic and anthropometric characteristics before postoperative recovery assessment.

The distribution of surgical procedures and comorbidities was comparable between the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups. Laparoscopic cholecystectomy was the most commonly performed procedure, accounting for 98 patients (98%) in the FTC group and all 100 patients (100%) in the MAS group, while laparoscopic hernioplasty and total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH with BSO) were each performed in one patient (1%) in the FTC group. The difference in the distribution of surgical procedures between the groups was not statistically significant (p = 0.955). Similarly, the prevalence of comorbidities was comparable, with hypertension present in 22% of patients in the FTC group and 17% in the MAS group, diabetes mellitus in 11% and 10%, respectively, and other comorbidities in 16% and 27% of patients. Overall, there was no statistically significant difference in the distribution of comorbid conditions between the two groups (p = 0.955), indicating that both groups had similar baseline clinical profiles.

The perioperative hemodynamic parameters were comparable between the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups at all measured time points. The mean systolic blood pressure before induction was 131.1 ± 17.6 mmHg in the FTC group and 131.3 ± 16.7 mmHg in the MAS group (p = 0.977). Following induction, the mean systolic blood pressure decreased to 114.6 ± 16.1 mmHg in the FTC group and 112.2 ± 15.9 mmHg in the MAS group (p = 0.463), while post-extubation values were 133.0 ± 15.7 mmHg and 134.9 ± 15.1 mmHg, respectively (p = 0.325). Similarly, the mean diastolic blood pressure was comparable between the groups before induction (81.9 ± 10.2 vs. 81.4 ± 11.5 mmHg; p = 0.880), after induction (76.4 ± 11.7 vs. 73.5 ± 12.5 mmHg; p = 0.214), and following extubation (86.4 ± 12.1 vs. 86.4 ± 11.2 mmHg; p = 0.782). None of the observed differences in systolic or diastolic blood pressure reached statistical significance, indicating that perioperative hemodynamic stability was comparable between patients assessed using the Fast Track Criteria and the Modified Aldrete Score.

The mean duration of surgery was comparable between the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups, with no statistically significant difference observed (91.4 ± 22.6 minutes vs. 89.8 ± 21.9 minutes, respectively; p = 0.612). However, postoperative recovery time was significantly shorter in the MAS group than in the FTC group. Patients assessed using the Modified Aldrete Score achieved recovery in a mean time of 17.2 ± 17.8 minutes compared with 21.9 ± 20.2 minutes in the Fast Track Criteria group, and this difference was highly statistically significant (p < 0.001). These findings indicate that while the duration of surgery was similar between the two groups, the Modified Aldrete Score was associated with a significantly faster postoperative recovery.

Postoperative recovery scores increased progressively over time in both the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups. However, the FTC group consistently demonstrated significantly higher mean recovery scores than the MAS group at every assessment interval. At 5 minutes, the mean score was 10.0 ± 1.7 in the FTC group compared with 6.9 ± 1.6 in the MAS group (p < 0.001). This difference remained statistically significant at 10 minutes (10.9 ± 1.6 vs. 7.6 ± 1.5), 20 minutes (11.9 ± 1.2 vs. 8.5 ± 1.2), 30 minutes (12.8 ± 1.2 vs. 9.1 ± 0.9), 1 hour (13.2 ± 0.9 vs. 9.8 ± 0.6), 2 hours (13.3 ± 0.7 vs. 9.8 ± 0.5), 6 hours (13.6 ± 0.6 vs. 9.9 ± 0.4), and 12 hours (13.8 ± 0.4 vs. 9.9 ± 0.3), with all comparisons showing highly significant differences (p < 0.001). These findings indicate that although recovery scores improved steadily in both groups, patients assessed using the Fast Track Criteria achieved consistently higher postoperative recovery scores throughout the observation period.

The present study demonstrated that the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups were comparable with respect to baseline demographic and clinical characteristics, thereby minimizing the potential influence of confounding variables on postoperative recovery outcomes. The majority of patients in both groups were aged 36–50 years, accounting for 45 patients (45%) in the FTC group and 42 patients (42%) in the MAS group, while patients aged ≤35 years comprised 39 (39%) and 45 (45%), respectively, and those aged >51 years constituted 16 (16%) and 13 (13%), with no significant difference in age distribution (p = 0.784). Females represented the majority of the study population, accounting for 73 patients (73%) in the FTC group and 71 patients (71%) in the MAS group, whereas males comprised 27 (27%) and 29 (29%), respectively (p = 0.755). Similarly, ASA physical status was evenly distributed, with ASA I observed in 60 patients (60%) in the FTC group and 56 patients (56%) in the MAS group, while ASA II was present in 40 patients (40%) and 44 patients (44%), respectively (p = 0.761). Anthropometric variables, including mean body weight, height, and BMI, were also comparable between the groups without statistically significant differences. These findings confirm that both groups were well balanced at baseline, ensuring that any observed differences in postoperative recovery are more likely attributable to the recovery assessment methods rather than variations in patient demographics or preoperative clinical characteristics. The findings of the present study are in agreement with those reported by White et al., who demonstrated that the Fast-Track Criteria provide a more comprehensive and clinically relevant assessment of postoperative recovery than the Modified Aldrete Score. [8]

The present study found that the distribution of surgical procedures and associated comorbidities was similar between the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups, indicating comparable baseline clinical characteristics. Laparoscopic cholecystectomy was the predominant surgical procedure, performed in 98 patients (98%) in the FTC group and all 100 patients (100%) in the MAS group, while laparoscopic hernioplasty and total laparoscopic hysterectomy with bilateral salpingo-oophorectomy (TLH with BSO) were each performed in only 1 patient (1%) in the FTC group, with no significant difference in surgical distribution (p = 0.955). Regarding comorbidities, hypertension was the most common condition, affecting 22 patients (22%) in the FTC group and 17 patients (17%) in the MAS group, followed by diabetes mellitus in 11 patients (11%) and 10 patients (10%), respectively. Other comorbid conditions were observed in 16 patients (16%) in the FTC group and 27 patients (27%) in the MAS group. Despite these variations, the overall distribution of comorbidities did not differ significantly between the two groups (p = 0.955). These findings suggest that both groups had comparable perioperative risk profiles, ensuring that differences in postoperative recovery outcomes are unlikely to have been influenced by variations in the type of surgery or pre-existing medical conditions. The findings of the present study are consistent with those reported by Kwee et al., who observed that patient-related factors, including the type of surgical procedure, ASA physical status, and pre-existing comorbidities, are important determinants of postoperative recovery and should be comparable between study groups to ensure a valid evaluation of recovery assessment tools. [9]

The present study demonstrated that perioperative hemodynamic parameters remained stable and comparable between the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups throughout the perioperative period. Mean systolic blood pressure was similar before induction (131.1 ± 17.6 mmHg in the FTC group vs. 131.3 ± 16.7 mmHg in the MAS group; p = 0.977), decreased following induction (114.6 ± 16.1 vs. 112.2 ± 15.9 mmHg; p = 0.463), and returned to near baseline after extubation (133.0 ± 15.7 vs. 134.9 ± 15.1 mmHg; p = 0.325). Likewise, mean diastolic blood pressure showed no significant differences between the two groups before induction (81.9 ± 10.2 vs. 81.4 ± 11.5 mmHg; p = 0.880), after induction (76.4 ± 11.7 vs. 73.5 ± 12.5 mmHg; p = 0.214), or following extubation (86.4 ± 12.1 vs. 86.4 ± 11.2 mmHg; p = 0.782). The expected reduction in blood pressure after induction and recovery following extubation was observed in both groups, reflecting the normal physiological response to general anaesthesia. Since no statistically significant differences were detected at any perioperative time point, these findings indicate that both the Fast Track Criteria and Modified Aldrete Score groups maintained comparable hemodynamic stability, suggesting that differences in postoperative recovery assessment were not influenced by variations in perioperative cardiovascular status. The findings of the present study are in accordance with those reported by Techanivate et al., who observed that patients undergoing laparoscopic surgery under general anaesthesia generally maintain stable perioperative hemodynamic parameters when standardized anaesthetic protocols are followed. [10]

The present study found that the duration of surgery was comparable between the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups, with mean operative times of 91.4 ± 22.6 minutes and 89.8 ± 21.9 minutes, respectively, showing no statistically significant difference (p = 0.612). This similarity indicates that both groups underwent procedures of comparable complexity and duration, thereby minimizing the influence of surgical factors on postoperative recovery. In contrast, a significant difference was observed in recovery time, with patients in the MAS group achieving recovery earlier than those in the FTC group (17.2 ± 17.8 minutes vs. 21.9 ± 20.2 minutes; p < 0.001). The shorter recovery time in the MAS group suggests that the Modified Aldrete Score facilitates earlier identification of patients who have achieved adequate postoperative recovery and are fit for discharge from the post-anaesthesia care unit (PACU). These findings indicate that although operative duration was similar in both groups, the Modified Aldrete Score was more efficient in assessing postoperative recovery, potentially contributing to improved patient throughput and more effective utilization of PACU resources. The findings of the present study are comparable with those reported by White et al., who compared the Fast-Track Criteria (FTC) with the Modified Aldrete Score (MAS) for assessing recovery after general anaesthesia. [10]

The present study demonstrated a progressive improvement in postoperative recovery scores over time in both the Fast Track Criteria (FTC) and Modified Aldrete Score (MAS) groups, reflecting the expected recovery pattern following general anaesthesia. The FTC group consistently recorded significantly higher mean recovery scores than the MAS group at every assessment interval, including 5 minutes (10.0 ± 1.7 vs. 6.9 ± 1.6), 10 minutes (10.9 ± 1.6 vs. 7.6 ± 1.5), 20 minutes (11.9 ± 1.2 vs. 8.5 ± 1.2), 30 minutes (12.8 ± 1.2 vs. 9.1 ± 0.9), 1 hour (13.2 ± 0.9 vs. 9.8 ± 0.6), 2 hours (13.3 ± 0.7 vs. 9.8 ± 0.5), 6 hours (13.6 ± 0.6 vs. 9.9 ± 0.4), and 12 hours (13.8 ± 0.4 vs. 9.9 ± 0.3), with all differences being highly statistically significant (p < 0.001). These findings reflect the differences in the scoring systems rather than differences in patients' physiological recovery, as the Fast Track Criteria has a higher maximum attainable score than the Modified Aldrete Score. Therefore, although FTC yielded consistently higher numerical recovery scores, both assessment tools demonstrated a steady improvement in postoperative recovery over time, supporting their effectiveness in monitoring patient recovery in the post-anaesthesia care unit.

This study demonstrated that the Fast Track Criteria (FTC) is a more effective tool than the Modified Aldrete Score (MAS) for assessing early postoperative recovery following laparoscopic surgical procedures under general anaesthesia. Patients evaluated with FTC consistently achieved higher recovery scores and fulfilled discharge readiness earlier than those assessed with MAS, without compromising patient safety. FTC provides a comprehensive assessment by incorporating physiological stability, pain control, and functional recovery, making it better suited for modern fast-track perioperative care. Therefore, the Fast Track Criteria may be considered a reliable and practical alternative to the Modified Aldrete Score for facilitating timely and safe postoperative recovery assessment and discharge decisions.

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