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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

*Department of Anaesthesia and Pain Management, Alfred Hospital; and 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 ( = 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 ( = -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 ( = 0.55, P < 0.0001), test-retest reliability (median = 0.61, P < 0.0001), and internal consistency ( = 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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