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Landau R. Connecting the dots between inpatient quality of obstetric recovery and postpartum depression: Are we ready for a cultural shift? J Clin Anesth 2024; 96:111372. [PMID: 38161081 DOI: 10.1016/j.jclinane.2023.111372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Affiliation(s)
- Ruth Landau
- Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168(th) Street, New York, NY 10032, USA..
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Li Q, Xu S, Ou Y, Zhou L, Huang F, Jiang W, Xie H, Zou X, Gao J, Jin S, Zhou H, Huang Y, Pan Z, Liu J, Wang G, Li X, Sun C, Zhao L, Li L, Liu Q, Duan K, Wang S. Evaluating the efficacy and safety of perianal injection of liposomal ropivacaine HR18034 for postoperative analgesia following hemorrhoidectomy: A multicenter, randomized, double-blind, controlled phase II clinical trial. J Clin Anesth 2024; 97:111524. [PMID: 38941870 DOI: 10.1016/j.jclinane.2024.111524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/30/2024]
Abstract
STUDY OBJECTIVE HR18034, composed of the ropivacaine encapsulated in multi-lamellar, concentric circular structure liposomes as the major component and a small amount of free ropivacaine, has performed well in animal experiments and phase I clinical trials. This trial was to investigate the efficacy, safety, pharmacokinetic profile and the minimum effective dose of HR18034 for postoperative analgesia after hemorrhoidectomy compared with ropivacaine. DESIGN A multicenter, randomized, double-blind trial. SETTING 19 medical centers in China. PATIENTS 85 patients undergoing hemorrhoidectomy between October 2022 to November 2022. INTERVENTIONS Patients were randomly divided into HR 18034 190 mg group, 285 mg group, 380 mg group and ropivacaine 75 mg group, receiving single local anesthetic perianal injection for postoperative analgesia. MEASUREMENTS The primary outcome was the area under the resting state NRS score -time curve within 72 h after injection. The second outcomes included the proportion of patients without pain, the proportion of patients not requiring rescue analgesia, cumulative morphine consumption for rescue analgesia, etc. Safety was evaluated by adverse events incidence and plasma ropivacaine concentrations were measured to explore the pharmacokinetic characteristics of HR18034. MAIN RESULTS The areas under the NRS score (at rest and moving states)-time curve were significantly lower in HR 18034 380 mg group than ropivacaine 75 mg at 24 h, 48 h, and 72 h after administration. However, this superiority was not observed in HR18034 190 mg group and 285 mg group. There was no difference in cumulative morphine consumption for rescue analgesia between HR 18034 groups and ropivacaine group. CONCLUSIONS HR 18034 380 mg showed superior analgesic efficacy and equivalent safety compared to ropivacaine 75 mg after hemorrhoidectomy, thus preliminarily determined as minimum effective dose.
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Affiliation(s)
- Qiuwen Li
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Shouyu Xu
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Yangwen Ou
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Lianbang Zhou
- The Second Affiliated Hospital of Anhui Medical University, Hefei 230022, People's Republic of China
| | - Furong Huang
- The First People's Hospital of Changde, Changde, People's Republic of China
| | - Wanwei Jiang
- Affiliated Zhongshan Hospital of Dalian University, Dalian 116011, People's Republic of China
| | - Haihui Xie
- Dongguan people's Hospital, Dongguan, Guangdong, People's Republic of China
| | - Xiaohua Zou
- The Affiliated Hospital of Guizhou Medical University, Guiyang, People's Republic of China
| | - Jihua Gao
- Traditional Chinese Medicine Hospital of Hebei Province, Shijiazhang,People's Republic of China
| | - Shu''an Jin
- Central Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
| | - Hongmei Zhou
- Jiaxing Second Hospital, Jiaxing, People's Republic of China
| | - Yanjuan Huang
- Nanning Second People's Hospital, Nanning, People's Republic of China
| | - Zhihao Pan
- Li Huili Hospital of Ningbo Medical Center, Ningbo, People's Republic of China
| | - Juying Liu
- Taihe Hospital Affiliated Hospital of Hubei University of medicine, Shiyan, People's Republic of China
| | - Guyan Wang
- Beijing Tongren Hospital Affiliated to Capital Medical University, Beijing, People's Republic of China
| | - Xiangkui Li
- Sichuan Provincial People's Hospital, Chengdu, People's Republic of China
| | - CanLin Sun
- Taizhou People's Hospital, Taizhou, People's Republic of China
| | - Ling Zhao
- The First Affiliated Hospital of Xi'an Medical University, Xi'an, People's Republic of China
| | - Lin Li
- General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Qin Liu
- Jiangsu Hengrui Pharmaceuticals Co, Ltd, Shanghai, China
| | - Kaiming Duan
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China
| | - Saiying Wang
- The Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, People's Republic of China.
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Guevara J, Sánchez C, Organista-Montaño J, Domingue BW, Guo N, Sultan P. Development and validation of a Spanish version of the Obstetric Quality of Recovery-10 item score (ObsQoR-10-Spanish). BJA OPEN 2024; 10:100269. [PMID: 38560622 PMCID: PMC10978479 DOI: 10.1016/j.bjao.2024.100269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024]
Abstract
Background Spanish is the second most spoken language globally with around 475 million native speakers. We aimed to validate a Spanish version of the Obstetric Quality of Recovery-10 item (ObsQoR-10) patient-reported outcome measure. Methods ObsQoR-10-Spanish was developed using EuroQoL methodology. ObsQoR-10-Spanish was assessed in 100 Spanish-speaking patients undergoing elective Caesarean or vaginal delivery. Patients <38 weeks, undergoing an intrapartum Caesarean delivery, intrauterine death, or maternal admission to the intensive care unit (ICU) were excluded. Validity was assessed by evaluating (i) convergent validity-correlation with 24-h EuroQoL and global health visual analogue scale (GHVAS) scores (0-100); (ii) discriminant validity-difference in ObsQoR-10-Spanish score for patients with GHVAS scores >70 vs <70; (iii) hypothesis testing-correlation of ObsQoR score with maternal and neonatal factors; and (iv) cross-cultural validity assessed using differential item functioning analysis. Reliability was assessed by evaluating: (i) internal consistency; (ii) split-half reliability and (iii) test-retest reliability; and (iv) floor and ceiling effects. Results One hundred patients were approached, recruited, and completed surveys. Validity: (i) convergent validity: the ObsQoR 24-h score correlated moderately with the 24-h EuroQoL (r=-0.632) and GHVAS scores (r=0.590); (ii) discriminant validity: the ObsQoR-10-Spanish 24-h scores were higher in women who delivered vaginally compared to via Caesarean delivery, (mean [standard deviation] scores were 89 [9] vs 81 [12]; P<0.001). The 24-h ObsQoR-Spanish scores were lower in patients experiencing a poor vs a good recovery (mean [standard deviation] scores were 76 [12.3] vs 87.1 [10.6]; P=0.001); (iii) hypothesis testing: the ObsQoR-10 score correlated negatively with age (r=-0.207) and positively with 5-min (r=0.204) and 10-min (r=0.243) Apgar scores. Remaining correlations were not significant; and (iv) differential item functioning analysis suggested no potential bias among the 10 items. Reliability: (i) internal consistency was good (Cronbach alpha=0.763); (ii) split-half reliability was good (Spearman-Brown prophesy reliability estimate of 0.866); (iii) test-retest reliability was excellent with an intra-class correlation coefficient of 0.90; and (iv) floor and ceiling effects: six patients scored a maximum total ObsQoR-10 score. Conclusions The ObsQoR-10-Spanish patient-reported outcome measure is valid, reliable, and clinically feasible, and should be considered for use in Spanish-speaking women to assess quality of inpatient postpartum recovery.
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Affiliation(s)
- Jennifer Guevara
- Department of Anesthesiology, Clínica Universitaria Colombia, Bogotá, Colombia
| | - Carlos Sánchez
- Department of Anesthesiology, Clínica Universitaria Colombia, Bogotá, Colombia
| | | | | | - Nan Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, USA
| | - Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Division of Surgery and Interventional Science, Research Department of Targeted Intervention, University College London, London, UK
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Sabancı Baransel E, Barut S, Uçar T. The Effects Of Transcutaneous Electrical Nerve Stimulation Applied in the Early Postpartum Period After Cesarean Birth on Healing, Pain, and Comfort. J Midwifery Womens Health 2024. [PMID: 38470299 DOI: 10.1111/jmwh.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/20/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION This study was conducted to determine the effects of transcutaneous electrical nerve stimulation (TENS) applied in the early postpartum period after cesarean birth on incision site healing, postoperative recovery, pain, and comfort. METHODS This randomized, single-blind, placebo-controlled study was conducted with 138 women (TENS group n = 46, placebo group n = 46, control group n = 46) who gave birth by cesarean between January and September 2023. TENS was applied twice at a frequency of 100 Hz with a pulse width of 100 microseconds, at 10 to 12 and 14 to 16 hours after birth, for 30 minutes each. Outcomes were measured with the Postoperative Recovery Index; Redness, Edema, Ecchymosis, Discharge, and Approximation Scale; Visual Analogue Scale; and Postpartum Comfort Questionnaire. Outcomes between groups were compared postintervention, correcting for baseline using analysis of covariance. The study was registered at www. CLINICALTRIALS gov (NCT05991921). RESULTS Mean scores for postoperative recovery were significantly lower (improved) in the TENS group (113.58) compared with the placebo and control groups (134.67, 136.61; P < .001). The postoperative recovery subscales (psychological symptoms, physical activities, appetite symptoms, bowel symptoms, general symptoms) were also significantly decreased in the TENS group compared with the placebo and control groups. Similarly, mean scores for postpartum comfort, and the corresponding physical comfort, psychospiritual comfort, and sociocultural comfort subscales, were significantly improved in the TENS group (110.26) compared with the placebo and control group (83.80, 81.19; P < .05). DISCUSSION TENS application can be preferred as an alternative method to increase pain control, recovery, and patient comfort after cesarean birth.
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Affiliation(s)
| | - Sümeyye Barut
- Department of Midwifery, Fırat University, Elazığ, Turkey
| | - Tuba Uçar
- Department of Midwifery, İnönü University, Malatya, Turkey
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Morales JF, Gomez A, Carvalho J, Ye XY, Downey K, Siddiqui N. Quality of Recovery After Unplanned and Planned Cesarean Deliveries: A Prospective Observational Study Using the Obstetric Quality of Recovery-10 Tool. Anesth Analg 2024:00000539-990000000-00755. [PMID: 38381657 DOI: 10.1213/ane.0000000000006876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND There is a paucity of literature examining the differences between patient-reported outcome measures after planned and unplanned cesarean delivery using a validated quality of recovery tool. The Obstetric Quality of Recovery-10 (ObsQoR-10) scoring tool has been validated to quantify functional recovery after cesarean delivery. We aimed to use the ObsQoR-10 to compare the postoperative recovery characteristics of patients undergoing planned and unplanned cesarean deliveries. METHODS We conducted a prospective single-center observational study. Patients undergoing planned and unplanned cesarean deliveries under neuraxial anesthesia were asked to complete the ObsQoR-10 questionnaire 24 hours, 48 hours, and 1 week postpartum. We collected information on total in-hospital postoperative opioid consumption and patients´ perception of readiness for discharge at 24 and 48 hours postpartum. Additionally, patient characteristics were collected to assess their correlation with our findings. RESULTS We included 112 patients (56 in each group). No statistical differences in ObsQoR-10 scores at 24 hours, 48 hours, and 1 week postpartum were observed between the planned and unplanned cesarean deliveries. Additionally, there was no difference between the groups in patients' perception of readiness for hospital discharge at 24 and 48 hours and opioid consumption in the first 2 days after surgery. Most patients in both groups did not think they would be ready for discharge at 24 hours postpartum. Analysis of the individual components of ObsQoR-10 at 24 hours showed a difference in the responses assessing the severity of shivering (higher in unplanned cesarean deliveries) and the ability to look after personal hygiene (lower in unplanned cesarean deliveries). CONCLUSIONS As assessed by the ObsQoR-10, no significant difference in the quality of recovery was observed between patients undergoing planned and unplanned cesarean delivery.
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Affiliation(s)
- Juan F Morales
- From the Department of Anesthesia and Pain Management, Mount Sinai Hospital, University of Toronto, Toronto, Ontario Canada
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Kielty J, Borkowska A, Lawlor E, El-Khuffash AF, Doherty A, O'Flaherty D. Use of the Obstetric Quality-of-Recovery score (ObsQoR-11) to measure the impact of an enhanced recovery programme for elective caesarean section. Int J Obstet Anesth 2024; 57:103955. [PMID: 38030526 DOI: 10.1016/j.ijoa.2023.103955] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/06/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Enhanced recovery after caesarean (ERAC) has been shown to postoperatively reduce opioid consumption, reduce pain scores, and shorten hospital stay. Arguably, none of these measures provide for a patient-centred approach. We believe that patient-reported outcome measures (PROMs) represent a more holistic approach to the reporting of outcomes. One such PROM is the Obstetric Quality-of-Recovery Score (ObsQoR-11). This has been shown to be a valid and reliable assessment of recovery after elective caesarean section. METHODS This before-and-after quality improvement programme studied consecutive patients undergoing elective caesarean section. We implemented an ERAC pathway with the aim of improving quality of recovery and patient satisfaction. Our primary outcome was the change in the ObsQoR-11 score. RESULTS A total of 318 medical records were reviewed (n = 93 before ERAC, n = 225 after ERAC). There was a significant improvement in ObsQoR-11 score in ERAC patients compared with pre-ERAC patients (85.0 vs 82.3, P < 0.001). Morphine consumption (MMEQ) was reduced by 10% overall in the ERAC group, with no increase in pain scores at day 1 postoperatively and a decrease in pain scores on day 2 in the ERAC group (P = 0.02). The length of hospital stay was significantly shorter in ERAC patients (63.1 h vs 79.9 h, P < 0.001). CONCLUSIONS Our study demonstrated an improved ObsQoR-11 score after ERAC implementation. This is the first example in the literature of using ObsQoR-11 in ERAC. We believe this is a more comprehensive way to assess patient recovery and the impact of an ERAC programme.
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Affiliation(s)
- J Kielty
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland.
| | - A Borkowska
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - E Lawlor
- Department of Nursing and Midwifery, Rotunda Hospital, Dublin, Ireland
| | - A F El-Khuffash
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Doherty
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
| | - D O'Flaherty
- Department of Anaesthesia, Rotunda Hospital, Dublin, Ireland
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Shebelsky R, Sadi W, Heesen P, Aber RN, Fein S, Iluz-Freundlich D, Shmueli A, Azem K, Radyan Tamayev I, Binyamin Y, Orbach-Zinger S. The relationship between postpartum pain and mother-infant bonding: A prospective observational study. Anaesth Crit Care Pain Med 2024; 43:101315. [PMID: 37865216 DOI: 10.1016/j.accpm.2023.101315] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/10/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
INTRODUCTION Postpartum pain is associated with impaired maternal recovery and may influence mother-infant bonding. METHODS Participants who underwent a vaginal or cesarean delivery were assessed 24 h postpartum. Postpartum pain intensity was measured using the Verbal Numeric Score (VNS) (0-10) and classified as non-severe (<8) or severe pain (≥8). Maternal-infant bonding was evaluated using the Post-Partum Bonding Questionnaire (PBQ; 0-125), with a score > 5 defining impaired bonding. Demographic data included age, BMI, parity, education level, economic status, partnership, prior history of depression, familial history of depression, desire to breastfeed, epidural analgesia during labor, rooming in, and Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed using 2 separate multivariable logistic regression models for vaginal and cesarean deliveries, where maximum postpartum pain was the independent variable and impaired postpartum bonding was the dependent variable and controlled for the other factors collected. RESULTS Severe postpartum pain (VNS ≥ 8) showed no significant relationship with impaired bonding when controlling for confounding variables. In vaginal deliveries, there was an association between a history of depression and impaired bonding (Odds Ratio 2.2 [1.07-4.65], p = 0.04) and EPDS > 10 and impaired bonding (OR 11.5 [3.2-73.6], p < 0.001). For cesarean deliveries, rooming in with the baby had a protective effect (OR 11.5 [3.2-73.6], p < 0.001). CONCLUSIONS Contrary to expectations, severe postpartum pain did not influence maternal-infant binding in the cohort of patients with vaginal and cesarean deliveries. Instead, factors such as maternal mental health and rooming-in practices appeared to exert more significant influence. CLINICAL TRIAL REGISTRATION NCT05206552.
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Affiliation(s)
- Rostislav Shebelsky
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Wadeea Sadi
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | | | - Rachel N Aber
- Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Shai Fein
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Daniel Iluz-Freundlich
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Anat Shmueli
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Karam Azem
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Inbar Radyan Tamayev
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Sharon Orbach-Zinger
- Department, Department of Anaesthesia, Beilinson Hospital, Petach Tikvah, and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
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Ben Hayoun DH, Sultan P, Rozeznic J, Guo N, Carvalho B, Orbach-Zinger S, Weiniger CF. Association of inpatient postpartum quality of recovery with postpartum depression: A prospective observational study. J Clin Anesth 2023; 91:111263. [PMID: 37717463 DOI: 10.1016/j.jclinane.2023.111263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/30/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
STUDY OBJECTIVE To explore the relationship between Obstetric Quality of Recovery survey (ObsQoR-10-Heb) and Edinburgh postnatal depression scale (EPDS) measured 6 weeks after delivery, adjusted for potential confounding factors. DESIGN Prospective, longitudinal cohort study. SETTING Large postpartum department, 13,000 annual deliveries, quaternary medical center in Israel. PATIENTS Women ≥18 years old, gestational age ≥ 37 weeks after term delivery (spontaneous vaginal, operative vaginal, planned, and unplanned cesarean delivery), with non-anomalous neonates not requiring special support after delivery or at the time of recruitment. Written informed consent was provided. Women unable to read or understand Hebrew were excluded. INTERVENTIONS No interventions were done. MEASUREMENTS We investigated the relationship between inpatient postpartum recovery and positive postpartum depression (PPD) screening at 6 weeks postpartum. Enrolled women completed the validated Hebrew version of ObsQoR-10 survey (ObsQoR-10-Heb; scored between 0 and 100 with 0 and 100 representing worst and best possible recovery) from 24 to 48 h after delivery, and the Edinburgh Postnatal Depression Scale (EPDS) at 6- and 12 weeks postpartum. We assessed the univariate association between ObsQoR-10-Heb; patient factors; obstetric factors; and positive PPD screening at 6 weeks postpartum. Potential confounders were adjusted in a multiple logistic regression model. MAIN RESULTS Inpatient ObsQoR-10-Heb has been completed by 325 postpartum women; 270 (83.1%) and 253 (77.9%) completed the 6- and 12 weeks EPDS respectively. Lower ObsQoR-10-Heb (aOR 0.95 (95% CI 0.92, 0.98); p = 0.001); depression or anxiety before delivery (aOR 4.53 (95% CI 1.88, 10.90); p = 0.001); and hospital readmission (aOR 9.08 (95% CI 1.23, 67.14); p = 0.031) were associated with positive screening for postpartum depression at 6 weeks. CONCLUSIONS Our study demonstrates that worse inpatient postpartum recovery is an independent risk factor for positive PPD screening at 6 weeks postpartum. Other risk factors found in our study were maternal hospital readmission and a previous history of anxiety or depression.
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Affiliation(s)
| | - Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Jonathan Rozeznic
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical, Tel Aviv, Israel
| | - Nan Guo
- Stanford University School of Medicine, Stanford, California, United States
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, United States
| | - Sharon Orbach-Zinger
- Department of Anesthesiology, Rabin Medical Centre and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carolyn F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Battershell M, Vu H, Callander EJ, Slavin V, Carrandi A, Teede H, Bull C. Development, women-centricity and psychometric properties of maternity patient-reported outcome measures (PROMs): A systematic review. Women Birth 2023; 36:e563-e573. [PMID: 37316400 DOI: 10.1016/j.wombi.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 05/04/2023] [Accepted: 05/25/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Measuring maternity care outcomes based on what women value is critical to promoting woman-centred maternity care. Patient-reported outcome measures (PROMs) are instruments that enable service users to assess healthcare service and system performance. AIM To identify and critically appraise the risk of bias, woman-centricity (content validity) and psychometric properties of maternity PROMs published in the scientific literature. METHODS MEDLINE, CINAHL Plus, PsycINFO and Embase were systematically searched for relevant records between 01/01/2010 and 07/10/2021. Included articles underwent risk of bias, content validity and psychometric properties assessments in line with COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. PROM results were summarised according to language subgroups and an overall recommendation for use was determined. FINDINGS Forty-four studies reported on the development and psychometric evaluation of 9 maternity PROMs, grouped into 32 language subgroups. Risk of bias assessments for the PROM development and content validity showed inadequate or doubtful methodological quality. Internal consistency reliability, hypothesis testing (for construct validity), structural validity and test-retest reliability varied markedly in sufficiency and evidence quality. No PROMs received a level 'A' recommendation, required for real-world use. CONCLUSION Maternity PROMs identified in this systematic review had poor quality evidence for their measurement properties and lacked sufficient content validity, indicating a lack of woman-centricity in instrument development. Future research should prioritise women's voices in deciding what is relevant, comprehensive and comprehensible to measure, as this will impact overall validity and reliability and facilitate real-world use.
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Affiliation(s)
- M Battershell
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - H Vu
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - E J Callander
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - V Slavin
- Women-Newborn-Childrens Services, Gold Coast Health, QLD, Australia; School of Nursing and Midwifery, Griffith University, Meadowbrook, QLD, Australia
| | - A Carrandi
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - H Teede
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia; Endocrinology and Diabetes Units, Monash Health, VIC, Australia
| | - C Bull
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, VIC, Australia.
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Gupta S, Choudhary S, Choudhary V, Jain K, Bhatia N, Gupta A. Validation of Hindi version of the obstetric quality of recovery score-11 (ObsQoR-11 H) following elective caesarean section. Indian J Anaesth 2023; 67:S251-S256. [PMID: 38187972 PMCID: PMC10768900 DOI: 10.4103/ija.ija_69_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background and Aims Obstetric quality of recovery score-11 (ObsQoR-11) was developed in English to evaluate the quality of recovery in the caesarean section. We aimed to validate the Hindi version of ObsQoR-11 (ObsQoR-11H) for Hindi-speaking patients to evaluate the quality of recovery following the elective caesarean section. Methods The ObsQoR-11 was translated into Hindi and assessed for validity, acceptability and feasibility. The questionnaire was administered postoperatively at 24 and 48 hours, and the Global Health Numeric Rating Scale (NRS) was used to evaluate recovery. Results The mean (standard deviation [SD]) (95% confidence interval [CI]) ObsQoR-11 H was 75.94 (4.09)(95% CI 75.1, 76.7) and 80.25 (4.08)(95% CI 79.5, 81) at 24 and 48 hours, respectively. The mean (SD) (95%CI) Global Health NRS scores were 71.22 (5.97)(95% CI 70, 72.4) and 77.37 (5.79)(95% CI 76.2, 78.5) at 24 and 48 hours, respectively. Convergent validity showed a strong correlation between ObsQoR-11H and Global Health NRS (Spearman's correlation coefficient [rs] >0.8 and 0.78) scores at 24 and 48 hours, respectively. Discriminant validity was significant in appreciating the difference between good and poor recovery (P < 0.001). Split-half coefficient of 0.69 and 0.65 and Cronbach's alpha (α) of 0.91 and 0.82 at 24 and 48 hours suggested good score reliability. The acceptability and feasibility of the score were also good. Conclusion The ObsQoR-11H discriminated well between 'good' and 'poor' recovery and correlated strongly with Global Health NRS scores. It was found to be a valid, reliable, acceptable and feasible tool for psychometric recovery evaluation after elective caesarean section in Hindi-speaking women.
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Affiliation(s)
- Sunanda Gupta
- Department of Anaesthesiology and Critical Care, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Savita Choudhary
- Department of Anaesthesiology and Critical Care, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India
| | - Vidhu Choudhary
- Department of Anaesthesiology and Critical Care, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Nidhi Bhatia
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Apoorva Gupta
- Department of Anaesthesia and Critical Care, The Oxford Medical College Hospital and Research Centre, Bengaluru, Karnataka, India
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11
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Mazoué É, Veret M, Corroënne R, Mercier MB, Lomo H, Verhaeghe C, Lasocki S, Bouet PE, Léger M. Translation and validation of the French version of the ObsQoR-10 questionnaire for the evaluation of recovery after delivery: the ObsQoR-10-French. BJA OPEN 2023; 7:100221. [PMID: 37638079 PMCID: PMC10457490 DOI: 10.1016/j.bjao.2023.100221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/20/2023] [Indexed: 08/29/2023]
Abstract
Background The Obstetric Quality of Recovery-10 (ObsQoR-10) is a validated tool for assessing the quality of postpartum recovery. This study aimed to validate the French version of the ObsQoR-10 scale (ObsQoR-10-French). Methods After translating the ObsQoR-10 into French, we conducted a psychometric validation involving internal consistency, convergent validity, construct validity, reliability, responsiveness, scaling properties, acceptability, and feasibility. French women who underwent either a vaginal delivery (spontaneous or induced labour), or an emergency or elective Caesarean section (C-section) were prospectively included. They completed the ObsQoR-10-French before delivery and at 24 h (H24) and 48 h (H48) after delivery. Results Of the 500 women included, 431 (86%) completed the questionnaire at all three timepoints. A total of 352 women (82%) underwent vaginal delivery (with 228 [53%] experiencing spontaneous labour and 124 [29%] had labour induced), whereas 53 (12%) women underwent an emergency C-section and 26 (6%) an elective C-section. The ObsQoR-10-French demonstrated excellent internal consistency with a Cronbach's coefficient of 0.81, 95% confidence interval 0.78-0.84 at H24. The tool was correlated with an 11-item global health score (P<0.001). Of the list of hypotheses for evaluating the construct validity, 81% were confirmed (negative associations between ObsQoR-10-French and length of labour, hospital stay, the need for a C-section, and the emergency level of the C-section). The Cohen effect size at H24 was 0.58. The intra-class coefficient was 0.90, 95% confidence interval 0.86-0.93 at H24. Conclusion The ObsQoR-10-French is a valid and reliable psychometric questionnaire, capable of assessing the quality of postpartum recovery in French-speaking populations. Clinical trial registration NCT04489602.
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Affiliation(s)
- Éric Mazoué
- Department of Anaesthesia and Intensive Care, Angers University Hospital, France
| | - Mathilde Veret
- Department of Obstetrics and Gynaecology, Angers University Hospital, France
| | - Romain Corroënne
- Department of Obstetrics and Gynaecology, Angers University Hospital, France
| | | | - Henri Lomo
- Department of Anaesthesia and Intensive Care, Angers University Hospital, France
| | - Caroline Verhaeghe
- Department of Obstetrics and Gynaecology, Angers University Hospital, France
| | - Sigismond Lasocki
- Department of Anaesthesia and Intensive Care, Angers University Hospital, France
| | | | - Maxime Léger
- Department of Anaesthesia and Intensive Care, Angers University Hospital, France
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
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12
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Mazda Y, Ando K, Kato A, Noguchi S, Sugiyama T, Hizuka K, Nagai A, Ikeda Y, Sakamaki D, Guo N, Carvalho B, Sultan P. Postpartum recovery of nulliparous women following scheduled cesarean delivery and spontaneous vaginal delivery: a prospective observational study. AJOG GLOBAL REPORTS 2023; 3:100226. [PMID: 37334251 PMCID: PMC10276254 DOI: 10.1016/j.xagr.2023.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Inpatient postpartum recovery trajectories following cesarean delivery and spontaneous vaginal delivery are underexplored. OBJECTIVE This study primarily aimed to compare recovery following cesarean delivery and spontaneous vaginal delivery in the first postpartum week, and secondarily to evaluate psychometrically the Japanese version of the Obstetric Quality of Recovery-10 scoring tool. STUDY DESIGN Following institutional review board approval, the EQ-5D-3L (EuroQoL 5-Dimension 3-Level) questionnaire and a Japanese version of the Obstetric Quality of Recovery-10 measure were used to evaluate inpatient postpartum recovery in uncomplicated nulliparous parturients delivering via scheduled cesarean delivery or spontaneous vaginal delivery. RESULTS A total of 48 and 50 women who delivered via cesarean delivery and spontaneous vaginal delivery, respectively, were recruited. Women delivering via scheduled cesarean delivery experienced significantly worse quality of recovery on days 1 and 2 compared with those who had spontaneous vaginal delivery. Quality of recovery significantly improved daily, plateauing at days 4 and 3 for cesarean delivery and spontaneous vaginal delivery groups, respectively. Compared with cesarean delivery, spontaneous vaginal delivery was associated with prolonged time to analgesia requirement, decreased opioid consumption, reduced antiemetic requirement, and reduced times to liquid/solid intake, ambulation, and discharge. Obstetric Quality of Recovery-10-Japanese is a valid (correlates with the EQ-5D-3L including a global health visual analog scale, gestational age, blood loss, opioid consumption, time until first analgesic request, liquid/solid intake, ambulation, catheter removal, and discharge), reliable (Cronbach alpha=0.88; Spearman-Brown reliability estimate=0.94; and intraclass correlation coefficient=0.89), and clinically feasible (98% 24-hour response rate) measure. CONCLUSION Inpatient postpartum recovery is significantly better in the first 2 postpartum days following spontaneous vaginal delivery compared with scheduled cesarean delivery. Inpatient recovery is largely achieved within 4 and 3 days following scheduled cesarean delivery and spontaneous vaginal delivery, respectively. Obstetric Quality of Recovery-10-Japanese is a valid, reliable, and feasible measure of inpatient postpartum recovery.
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Affiliation(s)
- Yusuke Mazda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Drs Ando, Guo, Carvalho, and Sultan)
| | - Azusa Kato
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
| | - Shohei Noguchi
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
| | - Takayasu Sugiyama
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
| | - Kotaro Hizuka
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
| | - Azusa Nagai
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
| | - Yusuke Ikeda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
| | - Daisuke Sakamaki
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan (Drs Mazda, Kato, Noguchi, Sugiyama, Hizuka, Nagai, Ikeda, and Sakamaki)
| | - Nan Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Drs Ando, Guo, Carvalho, and Sultan)
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Drs Ando, Guo, Carvalho, and Sultan)
| | - Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA (Drs Ando, Guo, Carvalho, and Sultan)
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Dusitkasem S, Jindapitak J, Arnuntasupakul V, Lekprasert V, Bumrungphuet S, Sukying C, Komonhirun R, Sangkum L. Validation of the Thai version of the obstetric quality of recovery score (obsqor-10-Thai) after elective cesarean delivery. BMC Anesthesiol 2023; 23:72. [PMID: 36882676 PMCID: PMC9990285 DOI: 10.1186/s12871-023-02010-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 02/03/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The Obstetric Quality of Recovery score (ObsQoR-10) is a questionnaire used to assess recovery after cesarean delivery. However, the original ObsQoR-10 is in English and was mainly validated in the Western population. We therefore evaluated the reliability, validity, and responsiveness of the ObsQoR-10-Thai in patients undergoing elective cesarean delivery. METHODS The original ObsQoR-10 was translated into Thai, and psychometric validation was performed to evaluate the quality of post-cesarean recovery. The ObsQoR-10-Thai, activities of daily living checklist, and 100-mm visual analog scale of global health (VAS-GH) questionnaires were administered to the study participants before and 24 and 48-h postpartum. Validity, reliability, responsiveness, and feasibility of the ObsQoR-10-Thai were assessed. RESULTS We included 110 patients undergoing elective cesarean delivery. The mean ObsQoR-10-Thai score at baseline and 24 and 48-h postpartum was 83.35 ± 11.15, 56.75 ± 11.6, and 70.96 ± 13.65, respectively. The ObsQoR-10-Thai score differed significantly between the two groups divided based on the VAS-GH (≥ 70 vs. < 70): 75.58 ± 13.81 and 52.56 ± 10.61, respectively (P < 0.001). The convergent validity between the ObsQoR-10-Thai and VAS-GH was good (r = 0.60, P < 0.001). The ObsQoR-10-Thai displayed good internal consistency (Cronbach's alpha = 0.87), split-half reliability (0.92), and test-retest reliability (0.99, 95% CI: 0.98-0.99). The median time to complete the questionnaire was 2 (IQR, 1-6) min. CONCLUSIONS Our findings indicate that the ObsQoR-10-Thai is valid and has good reliability, with a high degree of responsiveness in terms of assessment of recovery after elective cesarean delivery. TRIAL REGISTRATION This study was registered on the Thai Clinical Trials Registry, identifier TCTR20210204001, registered on 04/02/2021 (Prospectively registration).
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Affiliation(s)
- Sasima Dusitkasem
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Jinda Jindapitak
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Vanlapa Arnuntasupakul
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Varinee Lekprasert
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Sommart Bumrungphuet
- 270 Department of Obstetrics and Gynecologics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Chakrit Sukying
- 270 Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Rojnarin Komonhirun
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand
| | - Lisa Sangkum
- 270 Department of Anesthesiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Rama VI Road, Phayathai, Ratchatewi, Bangkok, 10400, Thailand.
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14
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Dagasan Cetin G, Dostbil A, Aksoy M, Kasali K, Ince R, Kahramanlar AA, Atalay C, Topdagi Yilmaz EP, Ince I, Ozkal MS. Intraperitoneal instillation versus wound infiltration for postoperative pain relief after cesarean delivery: A prospective, randomized, double-blind, placebo-controlled trial. J Obstet Gynaecol Res 2023; 49:209-219. [PMID: 36270632 DOI: 10.1111/jog.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 01/19/2023]
Abstract
AIM To compare local anesthetic wound infiltration with intraperitoneal instillation of local anesthetic for analgesia after cesarean section under spinal anesthesia. METHODS This study was conducted on 150 pregnant women undergoing elective cesarean section under spinal anesthesia. Spinal anesthesia was performed with 7 mg isobaric bupivacaine and 15 μcg fentanyl. The patients were randomized into three groups of 50 patients each: Group local anesthetic wound infiltration (LWI): 20 ml local anesthetic solution (10 ml 0.5% bupivacaine and 10 ml 2% lidocaine mixture) was administered subcutaneous wound infiltration at the end of surgery prior to skin closure and 20 ml saline was instilled into the uterine peritoneal area before fascia closure. Group intraperitoneal local anesthetic (IPLA): 20 ml local anesthetic solution (10 ml 0.5% bupivacaine and 10 ml 2% lidocaine mixture) was instilled into the uterine peritoneal area and 20 ml saline was administered subcutaneous wound infiltration. Group Placebo: 20 ml saline was instilled into the uterine peritoneal area and 20 ml saline was administered local subcutaneous wound infiltration. Pain scores at rest and on movement, total fentanyl consumption at 24 h, maternal satisfaction, and the time to first analgesic request were recorded. RESULTS No statistically significant difference was observed in the postoperative pain scores at rest at 2, 12, and 24 h (p = 0.314, 0.343, and 0.735, respectively) and on movement at 12 and 24 h (p = 0.318 and 0.642, respectively) between the groups. The pain scores on movement at 2 h were significantly lower in Group IPLA compared with Group Placebo (p = 0.047). There were no significant differences between the groups in terms of total fentanyl consumption and the time to first analgesic request. CONCLUSION The use of intraperitoneal instillation of bupivacaine and lidocaine reduces early the pain score on movement in women undergoing cesarean section under spinal anesthesia.
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Affiliation(s)
- Gozdenur Dagasan Cetin
- Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Aysenur Dostbil
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Mehmet Aksoy
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Kamber Kasali
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.,Department of Biostatistics, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ramazan Ince
- Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Agah Abdullah Kahramanlar
- Department of Anesthesiology and Reanimation, University of Health Sciences, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Canan Atalay
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey.,Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey
| | - Emsal Pınar Topdagi Yilmaz
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.,Department of Obstetrics and Gynecology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ilker Ince
- Anesthesiology Clinical Research Office, Ataturk University, Erzurum, Turkey.,Department of Anesthesiology and Reanimation, Altınbas University, İstanbul, Turkey
| | - Mırac Selcen Ozkal
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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15
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Chou WH, Lee SO, Sun MH, Tseng YC, Chan KC, Chen YH, Wu CY. Validation of Chinese version of a global anesthetic recovery questionnaire: A multicenter observational trial on ObsQoR-11. J Formos Med Assoc 2022; 122:479-485. [PMID: 36593133 DOI: 10.1016/j.jfma.2022.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 12/09/2022] [Accepted: 12/14/2022] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The obstetric quality of recovery (ObsQoR-11) is considered one of the best patient-reported outcome measures of post-cesarean recovery. However, it has been neither validated in Chinese nor evaluated at >24 h after delivery. METHODS Parturients from three hospitals (n = 279) completed the Chinese ObsQoR-11 at 24 h (T1) and 96 h (T2) after elective cesarean delivery. Convergent validity was assessed by correlation of Chinese ObsQoR-11 with a 100-mm numerical rating scale (NRS) of general health status; discriminant validity of good recovery (NRS ≥ 70-mm); and construct validity by correlation with influential factors to post-cesarean recovery. The reliability and responsiveness were also assessed. RESULTS The Chinese ObsQoR-11 correlated moderately with the NRS [T1: r = 0.38 (95% confidence interval: 0.28-0.48), p < 0.0001; T2: r = 0.43 (95% confidence interval: 0.32-0.52), p < 0.0001] and discriminated between good and poor recovery [T1: mean (SD) score: 64 (20) vs 49 (17), p < 0.0001; T2: median (IQR) score: 81 (66-94) vs. 61 (53-72); p = 0.0002]; weakly correlated with gestational age, successful breastfeeding, and operation time. It was reliable (internal consistency: 0.75 (T1) and 0.82 (T2); split-half: 0.77 (T1) and 0.85 (T2); test-retest intraclass correlation coefficient r > 0.6 for each item) and responsive (Cohen effect size: 0.88; standardized response mean: 0.81). CONCLUSION The Chinese ObsQoR-11may be used for assessing recovery at 24 h and 96 h after cesarean delivery. However, its' cutoff value for good recovery may be lower than that of other versions.
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Affiliation(s)
- Wei-Han Chou
- Department of Anesthesiology, National Taiwan University Hospital, Taiwan
| | - Sing-Ong Lee
- Department of Anesthesiology, Hsinchu Cathay General Hospital, Taiwan
| | - Min-Hsuan Sun
- Department of Anesthesiology, National Taiwan University Hospital, Yunlin Branch, Taiwan
| | - Ying-Chih Tseng
- Department of Gynecology and Obstetrics, Hsinchu Cathay General Hospital, Taiwan
| | - Kuang-Cheng Chan
- Department of Anesthesiology, National Taiwan University Hospital, Taiwan
| | - Ying-Hsi Chen
- Department of Anesthesiology, National Taiwan University Hospital, Taiwan
| | - Chun-Yu Wu
- Department of Anesthesiology, National Taiwan University Hospital, Taiwan.
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16
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Ozkan G, Kara U, Ince ME, Ozdemir O, Ulubay M, Senkal S. Validation of the Turkish version of the Obstetric Quality-of-Recovery score 11 (ObsQoR-11T) after cesarean delivery. Health Qual Life Outcomes 2022; 20:155. [PMCID: PMC9702850 DOI: 10.1186/s12955-022-02073-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 11/23/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
To translate and validate the psychometric characteristics of a Turkish version of the Obstetric Quality-of-Recovery score 11 tool used to measure post-cesarean delivery recovery in Turkish-speaking patients.
Methods
After the original English version of the Obstetric Quality-of-Recovery score 11 tool was translated into Turkish; it was psychometrically validated to assess the post-cesarean delivery quality of recovery. Validity, reliability, and feasibility were investigated. The Obstetric Quality-of-Recovery score 11 tool was administered to Turkish-speaking patients on postoperative day 1. On postoperative day 1, a global health visual analog scale was used to assess the patient's perceived global recovery.
Results
One hundred and eighty-six patients completed their questionnaires, providing a completion rate of 97.38%. The Spearman rho (ρ) correlation coefficient between the Obstetric Quality-of-Recovery score and global health visual analog scale (0–100 points) was 0.850 at postoperative day 1 following surgery (P < 0.001). Internal consistency, measured using Cronbach’s alpha, was 0.822. The split-half coefficient was 0.708. The Obstetric Quality-of-Recovery score differed significantly between the emergency and elective cesarean delivery groups (80 (41–104) vs. 83.3 (51–102); P < 0.05). The test–retest reliability of the Obstetric Quality-of-Recovery score items was more than 0.6 in 82% of cases, indicating good repeatability and reliability.
Conclusion
The Obstetric Quality-of-Recovery score 11 is a valid and reliable tool to measure the post-cesarean quality of recovery in Turkish-speaking patients. The psychometric properties of the Turkish version of the scale to measure the post-cesarean quality of recovery were similar to those of the seminal English version.
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17
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Providing and Measuring Quality Postpartum Care. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00340-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Mathias LAST, Carlos RV, Siaulys MM, Gabriades P, Guo N, Domingue B, O'Carroll J, Carvalho B, Sultan P. Development and validation of a Portuguese version of Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese). Anaesth Crit Care Pain Med 2022; 41:101085. [PMID: 35487408 DOI: 10.1016/j.accpm.2022.101085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We aimed to develop and validate a Portuguese version of the Obstetric Quality of Recovery-10 (ObsQoR-10-Portuguese) patient-reported outcome measure and evaluate its psychometric properties. METHODS After ethical approval, we recruited term pregnant women undergoing uncomplicated elective cesarean delivery in a single Brazilian institution. Women were invited to complete the translated ObsQoR-10-Portuguese and EuroQoL (EQ-5D) questionnaires (including a global health visual analog scale [GHVAS]) at 24 h (±6 h) following delivery, and a subset of women an hour later. We assessed validity and reliability of ObsQoR-10-Portuguese. RESULTS One hundred thirteen enrolled women completed the surveys at 24 h and 29 women at 25 h (100% response rate). VALIDITY (i) convergent validity: ObsQoR-10-Portuguese correlated moderately with EuroQoL score (r = -0.587) and GHVAS score (r = 0.568) at 24 h. (ii) Discriminant validity: ObsQoR-10 discriminated well between good versus poor recovery (GHVAS score ≥ 70 versus < 70; difference in mean scores 14.2; p < 0.001). (iii) Hypothesis testing: 24-h ObsQoR-10-Portuguese scores correlated with gestational age (r = 0.191; p = 0.043). (iv) Cross-cultural validity: differential item functioning analysis suggested bias in 2 items. Reliability: (i) internal consistency was good (Cronbach's alpha = 0.82 and inter-item correlation = 0.31). (ii) Split-half reliability was very good (Spearman-Brown Prophesy Reliability Estimate = 0.80). (iii) Test re-test reliability was excellent (intra-class correlation coefficient = 0.87). (iv) Floor and ceiling effects: < 5% women scored either 0 or 100 (lowest and highest scores, respectively). CONCLUSION ObsQoR-10-Portuguese is valid and reliable, and should be considered for use in Portuguese-speaking women to assess their quality of inpatient recovery following cesarean delivery.
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Affiliation(s)
- L A S T Mathias
- Department of Anesthesiology, Pro Matre Paulista, Grupo Santa Joana, Sao Paulo, SP, Brazil
| | - R V Carlos
- Department of Anesthesiology, Pro Matre Paulista, Grupo Santa Joana, Sao Paulo, SP, Brazil; Department of Anesthesiology, Universidade de Sao Paulo, Hospital das Clínicas, Faculdade de Medicina, São Paulo, SP, Brazil
| | | | - P Gabriades
- Department of Anesthesiology, Pro Matre Paulista, Grupo Santa Joana, Sao Paulo, SP, Brazil
| | - N Guo
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Domingue
- Graduate School of Education, Stanford University, USA
| | - J O'Carroll
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - P Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Expert Consensus Regarding Core Outcomes for Enhanced Recovery after Cesarean Delivery Studies: A Delphi study. Anesthesiology 2022; 137:201-211. [PMID: 35511169 DOI: 10.1097/aln.0000000000004263] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heterogeneity among reported outcomes from enhanced recovery after cesarean delivery impact studies is high. This study aimed to develop a standardized enhanced recovery core outcome set for use in future enhanced recovery after cesarean delivery studies. METHODS An international consensus study involving physicians, patients and a director of Midwifery and Nursing Services, was conducted using a three-round modified Delphi approach (2 rounds of electronic questionnaires and a 3rd round e-discussion), to produce the core outcome set. An initial list of outcomes was based on a previously published systematic review. Consensus was obtained for the final core outcome set, including definitions for key terms, and preferred units of measurement. Strong consensus was defined as ≥70% agreement and weak consensus as 50-69% agreement. Of the 64 stakeholders who were approached, 32 agreed to participate. All 32, 31 and 26 stakeholders completed Rounds 1, 2 and 3, respectively. RESULTS The number of outcomes in the final core outcome set was reduced from 98 to 15. Strong consensus (≥70% stakeholder agreement) was achieved for 15 outcomes. The core outcome set included: length of hospital stay; compliance with enhanced recovery protocol; maternal morbidity (hospital re-admissions or unplanned consultations); provision of optimal analgesia (maternal satisfaction, compliance with analgesia, opioid consumption / requirement and incidence of nausea or vomiting); fasting times; breastfeeding success; and times to mobilization and urinary catheter removal. The Obstetric Quality of Recovery-10 item composite measure was also included in the final core outcome set. Areas identified as requiring further research included readiness for discharge and analysis of cost savings. CONCLUSIONS Results from an international consensus to develop a core outcome set for enhanced recovery after cesarean delivery are presented. These are outcomes that could be considered when designing future enhanced recovery studies.
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Metodiev Y, Lucas D. The role of total intravenous anaesthesia for caesarean delivery. Int J Obstet Anesth 2022; 51:103548. [DOI: 10.1016/j.ijoa.2022.103548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
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Cook MI, Kushelev M, Coffman JH, Coffman JC. Analgesic Outcomes in Opioid Use Disorder Patients Receiving Spinal Anesthesia with or without Intrathecal Clonidine for Cesarean Delivery: A Retrospective Investigation. J Pain Res 2022; 15:1191-1201. [PMID: 35478995 PMCID: PMC9037861 DOI: 10.2147/jpr.s358045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/10/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Meghan I Cook
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Correspondence: Meghan I Cook, The Ohio State University Wexner Medical Center, Department of Anesthesiology, N411 Doan Hall, 410 West 10th Ave, Columbus, OH, 43210, USA, Tel +1 614 293 8487, Fax +1 614 293 8153, Email
| | - Michael Kushelev
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Julie H Coffman
- Department of Internal Medicine, Riverside Methodist Hospital, Columbus, OH, USA
| | - John C Coffman
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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22
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Validation and Clinical Utility of the Korean Version of the Obstetric Quality-of-Recovery Score (ObsQoR-11) Following Elective Cesarean Section: A Prospective Observational Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12020291. [PMID: 35204382 PMCID: PMC8871019 DOI: 10.3390/diagnostics12020291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/27/2022] Open
Abstract
The Obstetric Quality of Recovery (ObsQoR-11) score is a new scoring tool that assesses maternal recovery after cesarean section (CS). We aimed to validate the translated Korean version of ObsQoR-11 (ObsQoR-11K) after elective CS. We validated ObsQoR-11K between March 2021 to August 2021. Validity (convergent, discriminant, and construct), reliability (Cronbach’s α, inter-item, split-half, and test-retest correlation), responsiveness, and clinical feasibility (recruitment rate and time for ObsQoR-11K completion) of ObsQoR-11K were evaluated. One hundred and twenty women completed the ObsQoR-11K 24 h after CS, and 24 women repeated it 25 h after CS. We found good convergent validity between the ObsQoR-11K score and the global health numerical rating scale (NRS) (ρ = 0.73 (95% CI 0.64 to 0.81); p < 0.001). The ObsQoR-11K score discriminated well between good (NRS ≥ 70 mm, n = 68, 69.6 ± 13.7) and poor recovery (NRS < 70 mm, n = 52, 50.6 ± 12.6, p < 0.001). The ObsQoR-11K score showed acceptable internal consistency (Cronbach’s α = 0.78), split-half reliability (0.89), intra-class correlation > 0.4, and no floor or ceiling effect. Of the participants, 100% completed the ObsQoR-11K and median (IQR) time for ObsQoR-11K completion was 81 s (66–97.5 s). ObsQoR-11K is a valid and reliable scoring tool for assessing maternal recovery after elective CS in Korean women.
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Bhiladvala C, Ffrench-O'Carroll R, Dadkhah Y, Bright S, Chau A, Seligman KM. Factors driving the difference in quality of recovery scores between scheduled and unscheduled Caesarean delivery patients. Br J Anaesth 2022; 128:e219-e221. [PMID: 35012740 DOI: 10.1016/j.bja.2021.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/31/2021] [Accepted: 11/16/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Cyrus Bhiladvala
- BC Women's Hospital and Health Centre, Department of Anesthesia, Vancouver BC, Canada
| | | | - Yeganeh Dadkhah
- BC Women's Hospital and Health Centre, Department of Anesthesia, Vancouver BC, Canada
| | - Susan Bright
- BC Women's Hospital and Health Centre, Department of Anesthesia, Vancouver BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Unversity of British Columbia, Vancouver, BC, Canada
| | - Anthony Chau
- BC Women's Hospital and Health Centre, Department of Anesthesia, Vancouver BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Unversity of British Columbia, Vancouver, BC, Canada
| | - Katherine M Seligman
- BC Women's Hospital and Health Centre, Department of Anesthesia, Vancouver BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Unversity of British Columbia, Vancouver, BC, Canada.
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Mukarram S, Ali S, Zulqurnain M, Alkadi IM, Alhatlan A, Abbasi MH, Mushtaq M, AbuHammad A, Shahid K, Waqas A, Shafqat A. Validation of translated Obstetric Quality of Recovery (ObsQoR-10A) score after nonelective cesarean delivery (CD) in an Arabic-speaking population. Saudi J Anaesth 2022; 16:390-400. [PMID: 36337390 PMCID: PMC9630706 DOI: 10.4103/sja.sja_52_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/13/2022] [Accepted: 02/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The ObsQoR-11 is a validated scale that assesses recovery after cesarean delivery (CD). This observational study aimed to evaluate the psychometric properties of its Arabic version. Methods: The original ObsQoR-11 was translated into an Arabic version (ObsQoR-10A). All participants completed the ObsQoR-10A at 24 h and 48 h postoperatively after CD. Validity, reliability, responsiveness, and feasibility were assessed. Results: The ObsQoR-10A correlated with Global Health Numerical Rating Scale (NRS) at 24 h (R = 0.68, 95% CI: 0.56–0.80, P < 0.001) and at 48 h (R = 0.66, 95% CI: 0.54–0.78, P < 0.001) and differentiated between good and poor recovery (median scores at 24 h 88 vs. 71, P < 0.001; at 48 h 95.5 vs. 70, P < 0.001). ObsQoR-10A correlated with hospital length of stay at 24 h (R = −0.21, 95% CI: −0.40 to −0.02, P = 0.03) and at 48 h (R = −0.21, 95% CI: −0.40 to −0.03, P = 0.02); gestational age at 24 h (R = 0.22, 95% CI: 0.03–0.40, P = 0.02); change in hemoglobin at 24 h (R = −0.30, 95% CI: 0.51 to −0.10, P < 0.01); and total opioids at 48 h (R = −0.45, 95% CI: −0.62 to −0.27, P < 0.001). There was a significant difference between 24 h and 48 h postoperative ObsQoR-10A scores (median difference: −18; P < 0.001 which shows responsiveness). Other key measures included a Cronbach's alpha of 0.87, split-half 0.75, and intra-class correlation >0.62 with no floor or ceiling effects. Median (IQR) completion time was 3 (3-5) and 3 (2.5-3.5) minutes at 24 h and 48 h. Conclusions: ObsQoR-10A is a valid, reliable, responsive, and a clinically feasible tool in an Arabic-speaking obstetric population.
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O’Carroll J, Carvalho B, Sultan P. Enhancing recovery after cesarean delivery – A narrative review. Best Pract Res Clin Anaesthesiol 2022; 36:89-105. [DOI: 10.1016/j.bpa.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/25/2022]
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Kumar S, Ashok V, Jain D, Arora A, Singh A, Sikka P. Validation of an obstetric quality of recovery scoring tool (ObsQoR-11) after elective caesarean delivery in a developing country: a prospective observational study. Int J Obstet Anesth 2021; 49:103235. [PMID: 34810053 DOI: 10.1016/j.ijoa.2021.103235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 09/12/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The obstetric quality of recovery scoring tool (ObsQoR-11) was developed and validated in the United Kingdom for use after elective and emergency caesarean delivery. Quality of recovery scoring tools validated in one country may not be valid in other countries with significant cultural, socio-economic and linguistic variations. The aim of the current study was to validate a Hindi version of the ObsQoR-11. METHODS In this prospective observational study, 100 parturients who underwent elective caesarean delivery in a tertiary care obstetric referral university hospital in North India were asked to complete a Hindi version of the ObsQoR-11 scoring tool 24 h after surgery. The performance of the Hindi version of ObsQoR-11 was assessed using measures of validity, reliability, and feasibility. RESULTS The Hindi version of ObsQoR-11 correlated moderately with the global health visual analogue scale (r=0.45, 95% CI 0.27 to 0.59; P <0.0001) and discriminated well between good and poor recovery (mean (SD) score 84.6 (9.4) vs 75.0 (11.2); P <0.0001). The reliability and internal consistency were moderate (Cronbach's alpha=0.66; Spearman-Brown Prophesy Reliability estimate=0.57) with good repeatability (intraclass correlation coefficient 0.85, 95% CI 0.69 to 0.93; P <0.0001) and no floor or ceiling effects. All parturients completed the questionnaire (median (IQR) time of completion of 3 (1.5 - 5.5) min). CONCLUSION The Hindi version of the ObsQoR-11 questionnaire is a promising scoring tool to evaluate quality of recovery after elective caesarean delivery. Further research is needed to evaluate the Hindi tool in other institutions in India, as well as in other languages.
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Affiliation(s)
- S Kumar
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - V Ashok
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India.
| | - D Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Arora
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - A Singh
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
| | - P Sikka
- Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh India
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Wilson RD, Nelson G. Maternal and fetal hypothermia: more preventive compliance is required for a mother and her fetus while undergoing cesarean delivery; a quality improvement review. J Matern Fetal Neonatal Med 2021; 35:8652-8665. [PMID: 34689687 DOI: 10.1080/14767058.2021.1993816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Cesarean delivery is common, involves two patients, has numerous multi-disciplinary health care providers involved in the delivery management, but has variable levels of anesthesia and health services implementation for decreasing maternal hypothermia and the maternal and neonatal morbidity (and mortality). Limited implementation for either of the ERAS-CD or the ERAC guidelines, for inadvertent or preventive maternal hypothermia, is likely to be occurring on labor delivery floors. This Quality Improvement (QI) review focuses on cesarean delivery and maternal hypothermia. METHODS This quality and safety initiative used SQUIRE 2.0 methodology and concurrent PubMed searches to identify systematic review, meta-analysis, topic directed studies, additional published cohorts in the topic area not included in SR/MA, limited case reports that had specific clinical outcomes related to maternal hypothermia and fetal effects. RESULTS Two quality and safety improvement guidelines have defined the hypothermia activity element differently, with ERAS-CD recommending to prevent hypothermia, while ERAC recommending to maintain normothermia. The peer-reviewed literature indicates that the knowledge associated with surgical hypothermia outcome is known but it is not implemented for maternal cesarean delivery care. Increased maternal-effect recognition, surveillance, triage, and evidenced-based protocol management is required for the maternal - neonatal dyad undergoing cesarean delivery for the clinical reduction/prevention of neonatal hypothermia that has proven evidence-based maternal morbidity and neonatal morbidity/mortality. CONCLUSION TEAM-based anesthesia, obstetrical, neonatology-pediatrics and nursing research collaboration is required through quality-safety-ERAS-ERAC directed processes. Healthcare system recognition and financial support is required for maternal-fetal-neonatal hypothermia prevention protocols implementation.
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Affiliation(s)
- R Douglas Wilson
- Department of Obstetrics and Gynecology, Cumming School of Medicine University of Calgary, Calgary, Canada
| | - Gregg Nelson
- Department of Obstetrics and Gynecology, Cumming School of Medicine University of Calgary, Calgary, Canada
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The Current Consideration, Approach, and Management in Postcesarean Delivery Pain Control: A Narrative Review. Anesthesiol Res Pract 2021; 2021:2156918. [PMID: 34589125 PMCID: PMC8476264 DOI: 10.1155/2021/2156918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/04/2021] [Indexed: 12/25/2022] Open
Abstract
Optimal postoperative analgesia has a significant impact on patient recovery and outcomes after cesarean delivery. Multimodal analgesia is the core principle for cesarean delivery and pain management. For a standard analgesic regimen, the use of long-acting neuraxial opioids (e.g., morphine) and adjunct drugs, such as scheduled acetaminophen and nonsteroidal anti-inflammatory drugs, is recommended unless contraindicated. Oral or intravenous opioids should be reserved for breakthrough pain. In addition to the aforementioned use of multimodal analgesia, preoperative evaluation is critical to individualize the analgesic regimen according to the patient requirements. Risk factors for severe postoperative pain or analgesia-related adverse effects will require modifications to the standard analgesic regimen (e.g., the use of ketamine, gabapentinoids, or regional anesthetic techniques). Further investigation is required to determine analgesic drugs or dose alterations based on preoperative predictions for patients at risk of severe pain. Outcomes beyond pain and analgesic use, such as functional recovery, should be determined to evaluate analgesic treatment protocols.
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Sultan P, Jensen SE, Taylor J, El-Sayed Y, Carmichael S, Cella D, Angst MS, Gaudilliere B, Lyell DJ, Carvalho B. Proposed domains for assessing postpartum recovery: a concept elicitation study. BJOG 2021; 129:9-20. [PMID: 34536324 DOI: 10.1111/1471-0528.16937] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/07/2021] [Accepted: 07/20/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To propose postpartum recovery domains. DESIGN Concept elicitation study. SETTING Semi-structured interviews. POPULATION Ten writing committee members and 50 stakeholder interviews (23 postpartum women, nine general obstetricians, five maternal and fetal medicine specialists, eight nurses and five obstetric anaesthetists). METHODS Alternating interviews and focus group meetings until concept saturation was achieved (no new themes discussed in three consecutive interviews). Interviews were digitally recorded and transcribed, and an iterative coding process was used to identify domains. MAIN OUTCOME MEASURES The primary outcome was to identify recovery domains. We also report key symptoms and concerns. Discussion frequency and importance scores (0-100; 0 = not important; 100 = vitally important to recovery) were used to rank domains. Discussion frequency was used to rank factors helping and hindering recovery, and to determine the greatest challenges experienced postpartum. RESULTS Thirty-four interviews and two focus group meetings were performed. The 13 postpartum recovery domains identified, (ranked highest to lowest) were: psychosocial distress, surgical/medical factors, infant feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance, sexual function and cognition. The most frequently discussed factors facilitating postpartum recovery were: family support, lactation/breastfeeding support and partner support. The most frequently discussed factor hindering recovery was inadequate social support. The most frequent challenges reported were: breastfeeding (week 1), breastfeeding (week 3) and sleep (week 6). CONCLUSIONS We propose 13 domains that comprehensively describe recovery in women delivering in a single centre within the USA. This provides a novel framework to study the postpartum recovery process. TWEETABLE ABSTRACT We propose 13 postpartum recovery domains that provide a framework to study the recovery process following childbirth.
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Affiliation(s)
- P Sultan
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
| | - S E Jensen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - J Taylor
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
| | - Y El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - S Carmichael
- Pediatrics, Obstetrics and Gynecology and Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA
| | - D Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - M S Angst
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
| | - B Gaudilliere
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
| | - D J Lyell
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - B Carvalho
- Department of Anesthesia and Perioperative Pain, Stanford University School of Medicine, Stanford, CA, USA
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Sultan P, Sharawi N, Blake L, Ando K, Sultan E, Aghaeepour N, Carvalho B, Sadana N. Use of Patient-Reported Outcome Measures to Assess Outpatient Postpartum Recovery: A Systematic Review. JAMA Netw Open 2021; 4:e2111600. [PMID: 34042993 PMCID: PMC8160591 DOI: 10.1001/jamanetworkopen.2021.11600] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Outpatient postpartum recovery is an underexplored area of obstetrics. There is currently no consensus regarding which patient-reported outcome measure (PROM) clinicians and researchers should use to evaluate postpartum recovery. OBJECTIVE To evaluate PROMs of outpatient postpartum recovery using Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines. EVIDENCE REVIEW An initial literature search performed in July 2019 identified postpartum recovery PROMs and validation studies. A secondary search in July 2020 identified additional validation studies. Both searches were performed using 4 databases (Web of Science, Embase, PubMed, and CINAHL), with no date limiters. Studies with PROMs evaluating more than 3 proposed outpatient postpartum recovery domains were considered. Studies were included if they assessed any psychometric measurement property of the included PROMs in the outpatient postpartum setting. The PROMs were assessed for the following 8 psychometric measurement properties, as defined by COSMIN: content validity, structural validity, internal consistency, cross-cultural validity and measurement invariance, reliability, measurement error, hypothesis testing, and responsiveness. Psychometric measurement properties were evaluated in each included study using the COSMIN criteria by assessing (1) the quality of the methods (very good, adequate, doubtful, inadequate, or not assessed); (2) overall rating of results (sufficient, insufficient, inconsistent, or indeterminate); (3) level of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations assessment tool; and (4) level of recommendation, which included class A (recommended for use; showed adequate content validity with at least low-quality evidence for sufficient internal consistency), class B (not class A or class C), or class C (not recommended). FINDINGS In total, 15 PROMs (7 obstetric specific and 8 non-obstetric specific) were identified, evaluating outpatient postpartum recovery in 46 studies involving 19 165 women. The majority of psychometric measurement properties of the included PROMs were graded as having very-low-level or low-level evidence. The best-performing PROMs that received class A recommendations were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF. The remainder of the evaluated PROMs had insufficient evidence to make recommendations regarding their use (and received class B recommendations). CONCLUSIONS AND RELEVANCE This review found that the best-performing PROMs currently available to evaluate outpatient postpartum recovery were the Maternal Concerns Questionnaire, the Postpartum Quality of Life tool, and the World Health Organization Quality of Life-BREF; however, these tools all had significant limitations. This study highlights the need to focus future efforts on robustly developing and validating a new PROM that may comprehensively evaluate outpatient postpartum recovery.
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Affiliation(s)
- Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Nadir Sharawi
- Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock
| | - Lindsay Blake
- Clinical Services,University of Arkansas for Medical Sciences, Little Rock
| | - Kazuo Ando
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Ellile Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Nima Aghaeepour
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Brendan Carvalho
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
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Abstract
PURPOSE OF REVIEW Limited guidance exists regarding how to assess postpartum recovery. In this article, we discuss various aspects of inpatient and outpatient postpartum recovery. RECENT FINDINGS The postpartum period for many women includes sleep deprivation, maternal-neonatal bonding, breastfeeding, and integrating a new life into the family unit. Factors which impact inpatient quality of recovery include pain, nausea or vomiting, dizziness, shivering, comfort, mobilization, ability to hold and feed the baby, personal hygiene maintenance, and feeling in control. Outpatient recovery domains include psychosocial distress, surgical/medical factors, feeding and breast health, psychosocial support, pain, physical function, sleep, motherhood experience, infant health, fatigue, appearance / cosmetic factors, sexual function, and cognition. Postpartum recovery is likely to take longer than six weeks; however, no consensus regarding recovery duration exists among professional societies. Obstetric quality of recovery (ObsQoR) is a recommended measure of inpatient postpartum recovery; however, studies are needed to determine the optimum outpatient recovery assessment tool. SUMMARY Postpartum recovery is an important area that requires clinical and research attention. Future studies should focus on identifying and developing valid, reliable, and responsive measures of recovery as well as tracking and optimizing recovery domains following all delivery modes. SUPPLEMENTARY VIDEO ABSTRACT ALSO AVAILABLE http://links.lww.com/COOG/A65.
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Affiliation(s)
- Pervez Sultan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
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The association between primary language and quality of recovery following caesarean section: a prospective observational study. Int J Obstet Anesth 2020; 44:68-73. [DOI: 10.1016/j.ijoa.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 07/02/2020] [Accepted: 07/15/2020] [Indexed: 12/28/2022]
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Evaluation of inpatient postpartum recovery using the Obstetric Quality of Recovery-10 patient-reported outcome measure: a single-center observational study. Am J Obstet Gynecol MFM 2020; 2:100202. [DOI: 10.1016/j.ajogmf.2020.100202] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/13/2020] [Accepted: 08/02/2020] [Indexed: 12/20/2022]
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Li XX, Li YM, Lv XL, Wang XH, Liu S. The efficacy and safety of intrathecal dexmedetomidine for parturients undergoing cesarean section: a double-blind randomized controlled trial. BMC Anesthesiol 2020; 20:190. [PMID: 32746864 PMCID: PMC7397624 DOI: 10.1186/s12871-020-01109-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy and safety of spinal anesthesia by intrathecal dexmedetomidine (DEX) for parturients undergoing cesarean section are still lack of evidence. This aim of our study was to evaluate the efficacy and safety of intrathecal DEX for parturients undergoing cesarean section to provide more data evidence for intrathecal applications. METHODS Three hundred parturients undergoing cesarean section under spinal anesthesia were randomly assigned into three groups: group B: 9.0 mg (1.2 ml) of 0.75% bupivacaine with saline (1 ml); group FB: 9.0 mg (1.2 ml) of 0.75% bupivacaine with 20 μg of fentanyl (1 ml); group DB: 9.0 mg (1.2 ml) of 0.75% bupivacaine with 5 μg of DEX (1 ml). Intraoperative block characteristics, parturients' postoperative quality of recovery, maternal and neonatal outcomes and the plasma concentration of DEX were measured. All parturients were followed up for 30 days to determine whether nerve injury occurred. RESULTS Compared with group B, the duration of sensory block in group FB and group DB were significantly prolonged (108.4 min [95% Confidence Interval (CI) = 104.6-112.3] in group B, and 122.0 min [95% CI = 116.8-127.3] in group FB, 148.2 min [95% CI = 145.3-151.1] in group DB). The overall score of quality recovery in group DB (71.6 [95% CI = 71.0-72.2]) was significantly higher than that in group FB (61.5 [95% CI = 60.8-62.2]) and group B (61.7 [95% CI = 61.0-62.4]). There was no statistically significant difference among the three groups for PH, PaO2, and PaCO2 of newborn. The plasma concentration of DEX in umbilical artery and umbilical vein was low and cannot be detected. The 30-days follow-up of parturients did not show any new onset of back, buttock or leg pain or paresthesia. CONCLUSIONS DEX is a potential local anesthetic adjuvant that the intrathecal combination of 5 μg DEX can safely exhibit a facilitatory block effect and improve parturients' recovery quality. TRIAL REGISTRATION Chinese Clinical Trial Registry (Registration number # ChiCTR1900022019 ; Date of Registration on March 20th, 2019).
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Affiliation(s)
- Xiao-Xiao Li
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yu-Mei Li
- Feng Xian People's Hospital of Jiangsu Province, Xuzhou, Jiangsu, China
| | - Xue-Li Lv
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xing-He Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Su Liu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, China. .,Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, 99 Huaihai West Road, Xuzhou, 221000, Jiangsu, China.
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Comparison of spontaneous versus operative vaginal delivery using Obstetric Quality of Recovery-10 (ObsQoR-10): An observational cohort study. J Clin Anesth 2020; 63:109781. [DOI: 10.1016/j.jclinane.2020.109781] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/28/2020] [Accepted: 03/07/2020] [Indexed: 02/07/2023]
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Shalev S, Orbach-Zinger S, Sultan P, Guo N, Ronel I, Davis A, Weiniger CF. Obstetric quality of recovery scoring tool: assessment of validity, reliability and feasibility in an Israeli cesarean delivery population. Int J Obstet Anesth 2020; 44:51. [PMID: 32799064 DOI: 10.1016/j.ijoa.2020.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/20/2020] [Indexed: 12/26/2022]
Affiliation(s)
- S Shalev
- Division of Anesthesia, Critical Care and Pain, TelAviv Sourasky Medical Center, Israel
| | - S Orbach-Zinger
- Department of Anesthesia, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - P Sultan
- Division of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - N Guo
- Division of Anesthesia, Stanford University School of Medicine, Stanford, CA, USA
| | - I Ronel
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Israel
| | - A Davis
- Department of Anesthesia, Rabin Medical Centre and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - C F Weiniger
- Division of Anesthesia, Critical Care and Pain, Tel Aviv Sourasky Medical Center, Israel.
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Sultan P, Sadana N, Sharawi N, Blake L, El-Boghdadly K, Falvo A, Ciechanowicz S, Athar W, Shah R, Guo N, Jensen S, El-Sayed Y, Cella D, Carvalho B. Evaluation of Domains of Patient-Reported Outcome Measures for Recovery After Childbirth: A Scoping and Systematic Review. JAMA Netw Open 2020; 3:e205540. [PMID: 32442292 PMCID: PMC7244991 DOI: 10.1001/jamanetworkopen.2020.5540] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Despite the global delivery rate being approximately 259 deliveries per minute in 2018, postpartum recovery remains poorly defined. OBJECTIVES To identify validated patient-reported outcome measures (PROMs) used to assess outpatient and inpatient postpartum recovery, evaluate frequency of PROM use, report the proportion of identified PROMs used within each recovery domain, report the number of published studies within each recovery domain, summarize descriptive data (country of origin, year of study, and journal specialty) for published studies using PROMs to evaluate postpartum recovery, and report PROMs used to evaluate global postpartum recovery. EVIDENCE REVIEW This study followed PRISMA-ScR guidelines. A literature search of 4 databases (MEDLINE through PubMed, Embase, Web of Science, and CINAHL) was performed on July 1, 2019, to identify PROMs used to evaluate 12 author-defined domains of postpartum recovery. All psychometrically evaluated PROMs used to evaluate inpatient or outpatient postpartum recovery after all delivery modes were included. FINDINGS From 8008 screened titles and abstracts, 573 studies (515 outpatient and 58 inpatient) were identified in this review. A total of 201 PROMs were used to assess recovery for outpatient studies and 73 PROMs were used to assess recovery for inpatient studies. The top 5 domains (with highest to lowest numbers of PROMs) used to assess outpatient recovery were psychosocial distress (77 PROMs), surgical complications (26 PROMs), psychosocial support (27 PROMs), motherhood experience (16 PROMs), and sexual function (13 PROMs). Among inpatient studies, the top 5 domains were psychosocial distress (32 PROMs), motherhood experience (7 PROMs), psychosocial support (5 PROMs), fatigue (5 PROMs), and cognition (3 PROMs). The 3 most frequently used PROMs were the Edinburgh Postnatal Depression Scale (267 studies), Short-Form 36 Health Questionnaire (global recovery assessment; 40 studies), and Female Sexual Function Index (35 studies). A total of 24 global recovery PROMs were identified among all included studies. Most studies were undertaken in the United States within the last decade and were published in psychiatry and obstetrics and gynecology journals. CONCLUSIONS AND RELEVANCE Most PROMs identified in this review evaluated a single domain of recovery. Future research should focus on determining the psychometric properties of individual and global recovery PROMs identified in this review to provide recommendations regarding optimum measures of postpartum recovery.
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Affiliation(s)
- Pervez Sultan
- Stanford University School of Medicine, Stanford, California
| | - Nishant Sadana
- Department of Anesthesia, Mercyhealth, Rockford, Illinois
| | - Nadir Sharawi
- Department of Anesthesia, University of Arkansas for Medical Sciences, Little Rock
| | - Lindsay Blake
- Department of Anesthesia, University of Arkansas for Medical Sciences, Little Rock
| | - Kariem El-Boghdadly
- Anaesthetic Service, Guy’s and St Thomas National Health Service Foundation Trust, London, United Kingdom
- The Anaesthetic Department, King’s College London, London, United Kingdom
| | - Andrea Falvo
- Anaesthetics Department, University College London Hospital, London, United Kingdom
| | - Sarah Ciechanowicz
- Anaesthetics Department, University College London Hospital, London, United Kingdom
| | - Waseem Athar
- Stanford University School of Medicine, Stanford, California
| | - Raj Shah
- Department of Anaesthesia, Watford General Hospital, Watford, United Kingdom
| | - Nan Guo
- Stanford University School of Medicine, Stanford, California
| | - Sally Jensen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Yasser El-Sayed
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Sharawi N, Klima L, Shah R, Blake L, Carvalho B, Sultan P. Evaluation of patient‐reported outcome measures of functional recovery following caesarean section: a systematic review using the consensus‐based standards for the selection of health measurement instruments (COSMIN) checklist. Anaesthesia 2019; 74:1439-1455. [DOI: 10.1111/anae.14807] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2019] [Indexed: 12/12/2022]
Affiliation(s)
- N. Sharawi
- Department of Anesthesiology University of Arkansas for Medical Sciences Little Rock AR USA
| | - L. Klima
- Department of Anesthesiology University of Arkansas for Medical Sciences Little Rock AR USA
| | - R. Shah
- Department of Anaesthesia University College London Hospital LondonUK
| | - L. Blake
- University of Arkansas for Medical Sciences Little Rock ARUSA
| | - B. Carvalho
- Stanford University School of Medicine Stanford CAUSA
| | - P. Sultan
- Stanford University School of Medicine Stanford CA USA
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