Development and Feasibility of a Scale to Assess Postoperative Recovery

Author:

Royse Colin F.1,Newman Stanton2,Chung Frances3,Stygall Jan4,McKay Rachel E.5,Boldt Joachim6,Servin Frederique S.7,Hurtado Ignacio8,Hannallah Raafat9,Yu Buwei10,Wilkinson David J.11

Affiliation:

1. Associate Professor, Anaesthesia and Pain Management Unit, Department of Pharmacology, University of Melbourne, Melbourne, Victoria, Australia, and Consultant Anaesthetist, Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.

2. Professor of Health Psychology and Honorary Consultant.

3. Professor, Department of Anaesthesia, University Health Network, University of Toronto, Toronto, Ontario, Canada.

4. Senior Research Fellow, Unit of Behavioural Medicine, University College London, London, United Kingdom.

5. Associate Professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California, and Attending Anesthesiologist, University of California, San Francisco Medical Center, San Francisco, California.

6. Professor of Anaesthesia and Intensive Care Medicine, Head of Department of Anaesthesia and Intensive Care Medicine, Klinikum der Stadt, Ludwigshafen, Ludwigshafen, Germany.

7. Consultant Anaesthetist, Department d'Anesthesiologie, Assistance Publique-Hôpitaux de Paris, Hopital Bichat, Paris, France.

8. Cardiovascular Anesthesiologist, Associate Professor, Universidad Autonoma de Mexico, Mexico City, Mexico, and Director, Anesthesia Department, American British Cowdray Medical Center, Mexico City, Mexico.

9. Professor of Anesthesiology and Pediatrics, The George Washington University Medical Center, Washington, D.C., and Division of Anesthesiology, Children's National Medical Center, Washington D.C.

10. Professor and Chairman, Department of Anesthesiology, Ruijin Hospital, Shanghai, China, and Shanghai Jiao Tong University, School of Medicine, Shanghai, China.

11. Emeritus Consultant Anaesthetist, Boyle Department of Anaesthesia, St. Bartholomew's Hospital, London, United Kingdom, and Chair, Post-operative Quality Recovery Scale (PQRS) Advisory Board, London, United Kingdom.

Abstract

Background Good postoperative recovery is increasingly recognized as an important outcome after surgery. The authors created a new Post-operative Quality Recovery Scale (PQRS) that tracks multiple domains of recovery from immediate to long-term time periods in patients of varying ages, languages, and cultures. Methods The parameters of importance to both clinicians and patients were identified. After an initial pilot study of 133 patients, the PQRS was refined. It consists of six domains (physiologic, nociceptive, emotive, activities of daily living, cognitive, and overall patient perspective). An observational study of 701 patients was performed with the refined PQRS to assess its capacity to evaluate and track recovery and to discriminate between patients. It was conducted in eight countries and in five languages, involving patients more than or equal to 6 yr undergoing elective surgery with general anesthesia. Recovery was assessed before surgery and at multiple time periods postoperatively. Recovery was defined as return to baseline values or better. Results Seven hundred one patients completed the PQRS. Mean completion time was 4.8 (SD 2.8) min. Recovery scores improved with time. Physiologic recovery was complete in 34% of subjects by 40 min. By the third postoperative day, complete recovery was obtained in 11% of cases (all domains): 48.7% nociceptive, 81.8% emotive, 68.8% activities of daily living, and only 33.5% cognitive. Overall, 95.8% of the patients reported that they were "satisfied or totally satisfied" with their anesthetic care. Conclusion The scores on the PQRS demonstrated an improvement over time, consistent with an expected recovery after surgery and anesthesia, and an ability to discriminate between individuals. Many patients had incomplete recovery by the third postoperative day.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

Reference46 articles.

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