Development and Feasibility of a Scale to Assess Postoperative Recovery

Abstract

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.

The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications

“…22 Enhanced Recovery After Surgery (ERAS) pathways now extend recovery to include three phases (up to discharge from the postanesthesia care unit, hospital discharge, and restitution of normal function), but they are still primarily focused on performance indicators in the immediate postoperative period. In comparison, the development of recovery assessment tools that address early (over days), 38,46 intermediate (over weeks), 39,41 and late (over months) 37,54 recovery allow for a broader and contextual assessment of persistent adverse symptoms, functional impairment, and cognitive decline beyond the traditional postoperative period.…”

“…[47][48][49][50][51] Assessment of cognitive recovery has thus progressed from simple assessments of orientation and comprehension 38,41,46 to more formal neuropsychological-based assessment. 26,37,52,53 More recent clinical recovery assessment tools, such as the Postoperative Quality of Recovery Scale (PostopQRS), 37 assess cognitive recovery by applying formal neuropsychological tests in truncated form and assessing patient recovery in relation to individual baseline function both in real time and over multiple time points.…”

“…10,12,22 Thus, an important advantage of a recovery assessment tool is its ability to aid in the assessment of recovery at multiple clinically relevant time points. By using validated repeat measures, 36,37,41 it can model the trajectory of recovery over time, from discharge (early recovery), to resumption of basic social activities (intermediate recovery), to resolution of full cognitive function (late recovery).…”

“…34 Traditional recovery assessment tools were institutional and focused on the provider, limiting assessment to addressing restitution of physiological parameters in the immediate postoperative period. 35 Historically, factors with a direct impact on discharge readiness and institutional cost were assessednausea and vomiting, severe pain, 36-39 psychological distress, 37,38,[40][41][42] and basic physiological function. [43][44][45] With the advent of patient-centred care, recovery has developed into a multidimensional construct, with recovery assessment tools addressing physical (nociceptive), [36][37][38][39] psychological (emotive, satisfaction), 37,38,[40][41][42] functional (ADLs), [36][37][38][39][40][41][42]46 and more recently, cognitive domains.…”

Standardizing endpoints in perioperative research

“…Then again, none of the suggested HRQL endpoints were developed for postoperative use except the Post-operative Quality of Recovery Scale (PQRS). 67 Since PQRS has been validated only up to three months postoperatively, the task force also highlighted the need for new instruments to assess long-term HRQL after surgery.…”