Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low‐baseline cognition

Bowyer, Andrea; Heiberg, Johan; Sessler, Daniel I.; Newman, Stanton; Royse, Alistair; Royse, Colin

doi:10.1111/anae.14402

Cited by 9 publications

(7 citation statements)

References 23 publications

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“…That is, patients can perform a little worse than baseline in the cognitive domain, by the magnitude of the tolerance factor, and still be scored as recovered. Patients whose pre‐surgery cognition values fall below the tolerance factor in one or more tests are categorised as ‘low baseline cognition’ and cognitive recovery is scored by the number of tests that score below the tolerance factor, and recovery is defined as the same or fewer tests scoring below the tolerance factor . The PostopQRS was conducted face‐to‐face whilst in hospital and then via telephone after hospital discharge.…”

Section: Methodsmentioning

confidence: 99%

“…The sample size estimate was based on the primary outcome of recovery in the cognitive domain of the PostopQRS at 7 days after surgery, and a clinically important difference in this outcome set at 15% between groups. Estimates of cognitive recovery were based on published PostopQRS research and using multiple ages and surgical cohorts . If there is ‘good recovery’ it was estimated that, for this surgical cohort and duration of surgery, cognitive recovery would range from 70% to 85% at 1 week after surgery.…”

Section: Methodsmentioning

confidence: 99%

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A randomised controlled trial comparing deep neuromuscular blockade reversed with sugammadex with moderate neuromuscular block reversed with neostigmine

et al. 2020

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Summary Deep neuromuscular block aims to improve operative conditions during laparoscopic surgery with a lower intra‐abdominal pressure. Studies are conflicting on whether meaningful improvements in quality of recovery occur beyond emergence, and whether lower intra‐abdominal pressure is achieved. In this pragmatic randomised trial with 1:1 allocation, adults undergoing elective laparoscopic surgery were allocated to moderate neuromuscular block reversed with neostigmine, or deep neuromuscular block reversed with sugammadex. Allocation was revealed to the anaesthetist only. Primary outcome was cognitive recovery of the Postoperative Quality of Recovery Scale, 7 days after surgery. Secondary outcomes included recovery in other domains of the Postoperative Quality of Recovery Scale at 15 min and 40 min; days 1, 3, 7, 14; and 1 and 3 months after surgery. Chi‐square test was used for the primary outcome, and generalised linear mixed model for recovery over time between groups. Of 350 participants randomised, 140 (deep) and 144 (moderate) were analysed for the primary outcome. There was no difference in the Postoperative Quality of Recovery Scale cognitive domain at day 7 (deep 92.9% vs. moderate 91.8%, OR 1.164; 95%CI 0.486–2.788, p = 0.826), or at any other time‐point. No significant difference was observed for physiological, emotive, activities of daily living, nociception, or overall recovery. Length of stay in the recovery area (mean (SD) deep 108 (58) vs. moderate 109 (57) min, p = 0.78) and hospital (1.8 (1.9) vs. 2.6 (3.5) days, p = 0.019) was not different. Intra‐abdominal pressure and surgical operating conditions were not different between groups. Deep neuromuscular block did not improve quality of recovery compared with moderate neuromuscular block in operative laparoscopic surgery over a 1‐h duration.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A randomised controlled trial comparing deep neuromuscular blockade reversed with sugammadex with moderate neuromuscular block reversed with neostigmine

et al. 2020

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“…Major complications and date of discharge were also recorded. For the calculation of the recovery scores, we followed the same rules published previously for the PostopQRS [2,3,7].…”

Section: Data Collectionmentioning

confidence: 99%

“…The assessment tool has been used to identify differences in the quality of recovery when comparing different operative procedures [4], anesthesia techniques [5], and therapeutic interventions [6]. It has also been extensively validated, including two modifications to the cognitive domain, in which a tolerance factor was included due to performance variability observed in human volunteers not undergoing surgery [3], and a method was introduced to score cognitive recovery in patients with low baseline cognition [7].…”

Section: Introductionmentioning

confidence: 99%

The validation of a Japanese language version of the postoperative quality of recovery scale: a prospective observational study

et al. 2021

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Background The Postoperative Quality of Recovery Scale (PostopQRS) is a survey-based tool that measures quality of the postoperative recovery in multiple domains over multiple time periods. The purpose of this study is to validate the Japanese version of the PostopQRS. Methods A prospective observational study using bilingual healthy volunteers was conducted in Australia to assess equivalence of the test values between the two languages. To assess the feasibility and discriminant validity of the PostopQRS in a Japanese population, an observational study was conducted on patients undergoing ear-nose-throat and orthopedic surgery in Japan, with measurements performed prior to surgery, 2 h, and 1, 3, and 7 days following surgery. The survey was conducted face-to-face while in hospital and via the telephone following discharge. Results Sixty-eight volunteers participated in the validation study. The scores in the Japanese version were similar to the English version in all domains at all timepoints. In the cognitive domain, there were no differences between the Japanese and English versions for word recall and word generation tasks. For digits forwards and digits backwards the values were skewed to the maximal value, and although significantly different, the absolute difference was <10% at all timepoints between English and Japanese versions. Fifty-one patients, ear-nose-throat (n=22) and orthopedic (n=29), were included in the clinical study. Orthopedic patients had a significantly worse recovery profile over time in overall recovery (p<0.01), physiological (p=0.02), nociceptive (p=0.03), and activities of daily living (ADL, p<0.01) domains, but was not different for emotive (p=0.30) or cognitive domains (p=0.10). Conclusion The Japanese version of the PostopQRS is similar to the English version and was able to discriminate recovery between different surgery disciplines. Trial registration UMIN, UMIN000033268, Registered 6 August 2018.

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“…A tolerance algorithm is used to adjust for normal variability observed in cognitive scoring. 20,21 Patients with poor preoperative cognitive function or impairment are automatically excluded from analysis as 'low baseline'; in an orthopaedic surgical patient population, this rate is estimated at between 5% and 15%. 18 A researcher collected baseline function in five PostopQRS domains using the standardised questionnaires prior to surgery and premedication.…”

Section: Postoperative Quality Of Recovery Measurementmentioning

confidence: 99%

Age-related differences in cognition and postoperative quality of recovery after beach chair position shoulder surgery

Chuan

Tran

Sun

et al. 2021

Anaesth Intensive Care

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We examined the influence of age in beach chair position shoulder surgery and postoperative quality of recovery by conducting a single-site, observational, cohort study comparing younger aged (18–40 years) versus older aged (at least 60 years) patients admitted for elective shoulder surgery in the beach chair position. Endpoints were dichotomous return of function to each patient’s individual preoperative baseline as assessed using the postoperative quality of recovery scale; measuring cognition, nociception, physiological, emotional, functional activities and overall perspective. We recruited 112 (41 younger and 71 older aged) patients. There was no statistical difference in cognitive recovery at day three postoperatively (primary outcome): 26/32 younger patients (81%) versus 43/60 (72%) older patients, P=0.45. Rates of recovery were age-dependent on domain and time frame (secondary outcomes), with older patients recovering faster in the nociceptive domain ( P=0.02), slower in the emotional domain ( P=0.02) and not different in the physiological, functional activities and overall perspective domains (all P >0.35). In conclusion, we did not show any statistically significant difference in cognitive outcomes between younger and older patients using our perioperative anaesthesia and analgesia management protocol. Irrespective of age, 70% of patients recovered by three months in all domains.

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Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low‐baseline cognition

Cited by 9 publications

References 23 publications

A randomised controlled trial comparing deep neuromuscular blockade reversed with sugammadex with moderate neuromuscular block reversed with neostigmine

A randomised controlled trial comparing deep neuromuscular blockade reversed with sugammadex with moderate neuromuscular block reversed with neostigmine

The validation of a Japanese language version of the postoperative quality of recovery scale: a prospective observational study

Age-related differences in cognition and postoperative quality of recovery after beach chair position shoulder surgery

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