Validity and reliability of a postoperative quality of recovery score: the QoR-40

Abstract

Quality of recovery after anaesthesia is an important measure of the early postoperative health status of patients. We attempted to develop a valid, reliable and responsive measure of quality of recovery after anaesthesia and surgery. We studied 160 patients and asked them to rate postoperative recovery using three methods: a 100-mm visual analogue scale (VAS), a nine-item questionnaire and a 50-item questionnaire; the questionnaires were repeated later on the same day. From these results, we developed a 40-item questionnaire as a measure of quality of recovery (QoR-40; maximum score 200). We found good convergent validity between QoR-40 and VAS (r = 0.68, P < 0.001). Construct validity was supported by a negative correlation with duration of hospital stay (rho = -0.24, P < 0.001) and a lower mean QoR-40 score in women (162 (SD 26)) compared with men (173 (17)) (P = 0.002). There was also good test-retest reliability (intra-class ri = 0.92, P < 0.001), internal consistency (Cronbach's alpha = 0.93, P < 0.001) and split-half coefficient (alpha = 0.83, P < 0.001). The standardized response mean, a measure of responsiveness, was 0.65. The QoR-40 was completed in less than 6.3 (4.9) min. We believe that the QoR-40 is a good objective measure of quality of recovery after anaesthesia and surgery. It would be a useful end-point in perioperative clinical studies.

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

“…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. QoR-40 may be more sensitive 31 for breast surgery.…”

“…Sample size was calculated based on a pilot study in which the rate of QoR 6 hours of 18 among control subjects in GA group was 0.36 and for experimental subjects in GA+ PVB group was 0.73 [14]. We need to study 32 experimental subjects in GA+ PVB group and 32 control subjects in GA group to be able to reject the null hypothesis that the rate of QoR=18 for experimental and control subjects are equal with probability of 0.8.…”

“…Despite the emphasis on measuring patient-oriented outcomes in many fields of health care and acceptance of these outcomes as a valid endpoint in clinical trials, [13][14][15] few studies have examined the effect of anesthesia-related complications on patient-oriented outcomes in the immediate postoperative period.…”

Patient-reported recovery after enhanced colorectal cancer surgery: a longitudinal six-month follow-up study

“…There are other instruments for assessing postoperative recovery in different respects; however, they are designed to evaluate recovery after anaesthesia, early postoperative phases, recovery during hospitalization, or recovery at home after ambulatory surgery [30,31]. The PRP questionnaire is a validated instrument which assesses self-reported, postoperative symptoms [2,32].…”

Uniportal non-intubated lung metastasectomy

“…Soon after the skin closure, the state of consciousness is always measured by the anesthesiologists with the Richmond Agitation Sedation Scale (18) that differentiates ten levels, from a score of +4 (combative) to −5 (unarousable). One hour after surgery, the patient himself is able to evaluate the postoperative recovery by the Quality of Recovery (QoR-40), which is a 40-item self-administered questionnaire (19). Each item is linked to a 5-point Likert scale [1][2][3][4][5] with a minimum cumulative score of 40 (global maximal impairment) and maximum of 200 (no impairment).…”