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

Abstract

Quality of recovery is a complex construct whose definition is influenced heavily by the opinions and biases of the individual patient, clinician, or institution. As a result, recovery assessment tools differ in their fundamental definitions of recovery, breadth, and assessment time frame. Accurate assessment of recovery is essential as suboptimal recovery has both economic and prognostic implications. Quality of care is often substituted as a surrogate at the institutional level for quality of recovery, but it is ideologically distinct from patients' perceived quality of care, recovery, and satisfaction. Recovery tools also differ in their assessment of recovery as a continuous vs dichotomous variable and in their focus at the group vs individual level. Ideally, recovery measures should assess outcomes in a simple dichotomous fashion and maintain relevancy by assessing in multiple domains at various time points. Assessment of recovery in a dichotomous fashion also has both clinical and research applications. It allows identification of suboptimal recovery at both individual and group levels, respectively, and when performed in real time, it allows the opportunity for timely targeted intervention specific to individual patients as well as for resource rationalization.Résumé La qualité de récupération est un construit complexe dont la définition est fortement influencée par les opinions et les biais du patient, du clinicien, voire de l'établissement. Dès lors, les outils d'évaluation de la récupération diffèrent de par la définition-même de la récupération, leur envergure, et le cadre temporel de l'évaluation. Une évaluation précise de la récupération est essentielle; en effet, une récupération sous-optimale a des implications tant économiques que pronostiques. Au niveau institutionnel, on utilise souvent la qualité des soins comme substitut de la qualité de récupération mais, d'un point de vue idéologique, ce concept se distingue de la qualité des soins, de la récupération et de la satisfaction telles que perçues par les patients. Les outils de récupération diffèrent également dans leur évaluation de la récupération en tant que variable continue ou dichotomique et dans leur emphase sur le groupe ou l'individu. Dans l'idéal, les mesures de la récupération devraient évaluer les pronostics de manière dichotomique simple et maintenir leur pertinence en évaluant plusieurs domaines à différents moments dans le temps. L'évaluation dichotomique de la récupération a également des applications cliniques et en recherche. Elle permet d'identifier une récupération sous-optimale tant au niveau du groupe que de l'individu. D'autre part, lorsque ce type d'évaluation est réalisé en temps réel, elle nous donne la possibilité d'intervenir d'une manière ciblée et opportune spécifique à chaque patient tout en rationnalisant les ressources.Author contributions Andrea Bowyer and Colin Royse contributed substantially to the conception and design of the manuscript and drafted the version to be published.

Development and validation of Arabic version of the postoperative quality of recovery scale

“…By identifying patients who did not recover in one or more domains at different time points, clinicians can make use of the information to implement additional treatments to improve the patients’ recovery profile. [11]…”

The association of patients' daily summarized self‐rated “real‐time” pain scores with physical recovery after major surgery – A repeated measurement design

“…Postoperative health‐related consequences are associated with the ability to recover, which means to “return to preoperative levels of independence/dependence in activities of daily living” (Allvin, Ehnfors, Rawal, & Idvall, ). Postoperative recovery involves nociceptive, emotional, functional and cognitive perspectives (Bowyer & Royse, ). Many factors contribute to patient recovery, such as psychological issues (Everhart, Best, & Flanigan, ; Flanigan, Everhart, & Glassman, ), preoperative health conditions, type of surgery and postoperative pain management (Ahmed, Lim, Khan, McNaught, & Macfie, ).…”

“…In the clinical context, “real‐time” recovery data are considered preferable to use as it can be used directly in clinical decisions (Bowyer & Royse, ). However, the spread of programmes for enhanced recovery in general and orthopaedic surgery has resulted in a high workload and limited time for healthcare professionals to collect extensive patient data.…”

“…This causes difficulties in introducing existing recovery assessment instruments. On the other hand, the absence of patient‐reported recovery measures may make it impossible to provide adequate individual interventions (Bowyer & Royse, ). Moreover, the absence of patient‐reported measures may also risk neglecting the philosophy of person‐centred care where patients' statements are fundamental in care decisions (Wallström & Ekman, ).…”

Virtual postoperative clinic: can we push virtual postoperative care further upstream?

“…Increasingly, virtual care will evolve from passive quality of recovery measurement to active real-time recovery 20. Real-time recovery uses quality of recovery assessments to implement early, aggressive course correction 7. For example, an ambulatory total knee replacement programme discharges patients home within 6 hours of surgery using a mobile app to track symptoms and biometric sensors to measure mobility, linking patients in real-time to the surgical team using 2-way video communication 21.…”