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Anesth Analg 1999;88:83-90
© 1999 International Anesthesia Research Society

ECONOMICS AND HEALTH SYSTEMS RESEARCH

Development and Psychometric Testing of a Quality of Recovery Score After General Anesthesia and Surgery in Adults

Paul S. Myles, MB BS, MPH, MD, FFARCSI, FANZCA*, Jennifer O. Hunt, RN, BHlthSc*, Claire E. Nightingale, MBChB, FRCA*, Helen Fletcher, RN*, Terence Beh, MBBS, FANZCA*, Deral Tanil, MBBS*, Attila Nagy, MBBS*, Alan Rubinstein, MBBS*, and Jennie L. Ponsford, MA, PhD{dagger}

*Department of Anaesthesia and Pain Management, Alfred Hospital; and {dagger}Department of Psychology, Bethesda Hospital, Prahan, Victoria, Australia

Address correspondence to Dr. Paul S. Myles, Department of Anaesthesia and Pain Management, The Alfred, Commercial Rd., Prahan, Victoria, 3181 Australia. Address e-mail to p.myles{at}alfred.org.au

A variety of methods have been used to quantify aspects of recovery after anesthesia. Most are narrowly focused, are not patient-rated, and have not been validated. We therefore set out to develop a patient-rated quality of recovery score. We constructed a 61-item questionnaire that asked individuals (patients and relatives, medical and nursing staff; total n = 136) to rate various postoperative items describing features a patient may experience postoperatively. The most highly ranked items were included in a final nine-point index score, which we called the "QoR Score." We then studied two cohorts of surgical patients (n = 449). There was good convergent validity between the QoR Score and the visual analog scale score ({rho} = 0.55, P < 0.0001). Discriminant construct validity was supported by comparing resultant QoR Scores in patients undergoing day-stay, minor, and major surgery (P = 0.008), as well as a negative correlation with duration of hospital stay ({rho} = -0.20, P < 0.0001), and, using multivariate regression, demonstrating a significant negative relationship between QoR Score and female gender (P = 0.048) and older age (P = 0.041). There was also good interrater agreement ({rho} = 0.55, P < 0.0001), test-retest reliability (median {rho} = 0.61, P < 0.0001), and internal consistency ({alpha} = 0.57 and 0.90, P < 0.0001). There was a significant difference between the groups of patients recovering from major and minor surgery (P < 0.001). This study demonstrates that the QoR Score has good validity, reliability, and clinical acceptability in patients undergoing many types of surgery.

Implications: We set out to develop a patient-rated quality of recovery score (QoR) that could be used both as a measure of outcome in perioperative trials and for clinical audit. We first surveyed patients and staff to identify important aspects of recovery, then developed a nine-point QoR Score. This was then compared with other measures of postoperative outcome. We found that the QoR Score is a useful measure of recovery after anesthesia and surgery.




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 1999 by the International Anesthesia Research Society.