Assessment of recovery after day surgery using a modified version of quality of recovery‐40

Abstract

A RECENT nationwide survey in Sweden found that day surgery accounts for 43% of all inhospital procedures. 1 Orthopaedic, general, and gynaecological procedures were the most common. About 40% of the day surgery units followed up with telephone calls within 1-2 days, and found pain to be the most common complaint. Quality of recovery had not been systematically evaluated with instruments tested for validity and reliability, and follow-ups beyond 2 days post-operative were not found.Quality of Recovery-40 (QoR-40) 2,3 is a 40-item instrument to assess the quality of post-operative recovery. The instrument is divided into five dimensions; emotional state, physical comfort, psychological support, physical independence, and pain. These dimensions represent aspects of good-quality recovery after anaesthesia and surgery. QoR-40 has been used for patients undergoing different surgical procedures and tests for validity and reliability yielded initial support for the instrument. Myles et al. 3 concluded that QoR-40 would be a useful outcome measure to assess the impact of changes in health care delivery on quality of care, but anaesthesia and surgery studies have rarely used this approach. Although QoR-40 has not been used exclusively for day surgery patients, some day surgery patients were included when the instrument was developed. 2,3 Another study on day surgery patients 4 used eight items from QoR-40 relevant to that study. In a systematic review of post-operative recovery outcomes measurements after ambulatory surgery, the QoR-40 was the only instrument that fulfilled the criteria that were set up but was not specifically designed for day surgery and anaesthesia. 5 Another systematic review from 2008 also advises to use the QoR-40 in

Validação da versão brasileira do questionário Quality of Recovery - 40 Items

“…(14) The QoR-40 responsiveness in other cultures was investigated between measures of pre-and postoperative periods, obtaining similar results -a moderate to significant effect. (15)(16)(17)(18) When investigating long term responsiveness, measurement between pre-and postoperative (90 days) of patients submitted to neurological surgeries, Australian researchers identified the QoR-40 good ability in detecting recovery changes (SRM>0.80). (19) The recovery monitoring over time showed that in the second return (about seven months after surgery), the QoR-40 scores were higher than the ones found in the preoperative period, characterizing an improvement in health status identified by the instrument.…”

“…The excluded items were from the dimensions physical comfort and pain, which did not present variability. (15) The same exclusion was identified in a study that developed a short version of the QoR-40. (19) This suggests that these items may not be essential to evaluate patients submitted to less invasive surgeries, as it was the case of the present study.…”

“…(3,5,18,20) The correlation of the QoR-40 with the VAS of surgical recovery was acceptable and superior when compared to values obtained in other cultures, whose results ranged from r=0.45 to 0.68. (3,5,15,16,18,19) …”

Anything Other than Pain that Matters after Breast Cancer Surgery? A Randomized Controlled Study Comparing Three Anesthetic Modalities

“…Minor nature of breast surgery, low postoperative pain level, and sensitivity of the nine-item QoR may have contributed to it. The modified QoR-40 [28] for day surgery adopted in Abdallah et al's recent study [12] might be more sensitive for breast surgery as they have demonstrated the difference. However, since ours were inpatients due to the institutional policy, the recovery questionnaires for the ambulatory setting [28][29][30] were not considered for our study.…”

“…The modified QoR-40 [28] for day surgery adopted in Abdallah et al's recent study [12] might be more sensitive for breast surgery as they have demonstrated the difference. However, since ours were inpatients due to the institutional policy, the recovery questionnaires for the ambulatory setting [28][29][30] were not considered for our study. QoR-40 [14] and nine-item QoR [22] was designed for both inpatient-and outpatient-surgeries.…”