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Hasfeldt D, Højberg Holm J, Lindberg-Larsen M, Overgaard S. Sense of coherence as a predictor for patients' quality of recovery after total hip or knee arthroplasty - A descriptive cohort study. Int J Orthop Trauma Nurs 2024; 54:101099. [PMID: 38593583 DOI: 10.1016/j.ijotn.2024.101099] [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: 09/20/2023] [Revised: 01/29/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Patients' postoperative quality of recovery (QOR) is an important outcome measurement and predicting and preventing impaired quality of recovery is essential. In this study, we aimed to investigate if patients Sense of Coherence (SOC) could be a potential predictor and screening instrument for impaired quality of recovery. We hypothesized that patients' SOC is positively related to their QOR. MATERIAL AND METHODS The study was performed as a descriptive single-center prospective cohort study. Data was collected using digital questionnaires. Patients undergoing total hip (THA) or knee arthroplasty (TKA) received the SOC13 questionnaire prior to their surgery to establish their SOC and a questionnaire on postoperative day 2 and 7, respectively, establishing their QOR. Multiple linear regression was used to fit a model for the QOR score using SOC, age, sex, and type of surgery as potential explanatory variables. RESULTS 206 patients were included in the study analysis. The results showed a highly significant positive correlation between patients' SOC and their postoperative QOR on both postoperative day 2 and 7 (p < 0.01). Patients with a lower SOC score also presented a significantly lower QOR score, meaning they experienced impaired QOR compared to patients with a higher SOC score. CONCLUSIONS The results indicate that a weak SOC (low SOC score) can be considered a clinically important indicator for risk of impaired QOR (low QOR score) after THA and TKA. The SOC13 questionnaire may be a potential screening instrument identifying patients in risk of impaired postoperative QOR based on a low SOC score.
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Affiliation(s)
- Dorthe Hasfeldt
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Jimmy Højberg Holm
- Department of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Martin Lindberg-Larsen
- Department of Orthopedic Surgery and Traumatology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløwparken 19, 3rd Floor, 5000, Odense, Denmark.
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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Mogianos K, Undén J, Persson A. Effect of individualized anesthesia and analgesia on postoperative pain in patients stratified for pain sensitivity: A study protocol for the PeriOPerative individualization trial randomized controlled trial. Acta Anaesthesiol Scand 2024. [PMID: 38937954 DOI: 10.1111/aas.14487] [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: 06/04/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Despite advancements in surgical and anesthesia techniques, acute and persistent postoperative pain are still a common challenge. Postoperative pain has direct effects on individual patient care and outcome, as well as putting strain on limited health care resources. Several prediction methods for postoperative pain have been described. One such method is the assessment of pain during peripheral venous cannulation (VCP). It is not known if different approaches to anesthesia and analgesia, depending on the evaluation of risk for postoperative pain, can improve outcome. The aim of this study is to evaluate if individualized anesthesia and analgesia can affect postoperative pain and recovery after surgery, in patients stratified by VCP. METHODS Adult patients scheduled for laparoscopic surgery undergo pain-sensitivity stratification using VCP on the day of surgery. Patients scoring VCP ≥2.0 on the visual analogue scale (pain-sensitive) are randomized to multimodal anaesthesia and analgesia with opioids or standard of care. Patients scoring VCP ≤1.9 (pain-tolerant) are randomized to opioid-free anaesthesia or standard of care. The primary outcome is acute postoperative pain measured with numeric rating scale in the postoperative care unit. Secondary outcomes include analysis of pain after 24 h, persistent postoperative pain and quality of recovery. DISCUSSION Individualized perioperative pain management has the potential to improve patient care. This study will examine the impact of different anesthesia and analgesia regimes, in patients with differing pain sensitivity, on postoperative pain. TRIAL REGISTRATION Prospectively posted at ClinicalTrials.gov, identifier NCT04751812.
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Affiliation(s)
- Krister Mogianos
- Department of Anesthesiology and Intensive Care Medicine, Halland Hospital Halmstad, Halmstad, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Johan Undén
- Department of Anesthesiology and Intensive Care Medicine, Halland Hospital Halmstad, Halmstad, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Anna Persson
- Department of Anesthesiology and Intensive Care Medicine, Halland Hospital Halmstad, Halmstad, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Le Bescond V, Petit-Phan J, Campfort M, Nicolleau C, Conté M, Bouhours G, Rony L, Lasocki S, Léger M. Validation of the postoperative Quality of Recovery-15 questionnaire after emergency surgery and association with quality of life at three months. Can J Anaesth 2024; 71:590-599. [PMID: 38504036 PMCID: PMC11026244 DOI: 10.1007/s12630-024-02722-4] [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: 08/08/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 03/21/2024] Open
Abstract
PURPOSE The Quality of Recovery-15 (QoR-15) tool, validated for measuring postoperative recovery following scheduled surgeries, has not been psychometrically assessed in emergency contexts. Moreover, the QoR-15's associations with long-term outcomes remain underexplored. This study aimed to confirm the validity and reliability of the QoR-15 following emergency surgery and assess its association with three-month postoperative quality of life. METHODS We conducted a prospective cohort study (August 2021-April 2022) on adult patients who underwent emergency surgery. The QoR-15 questionnaire was administered before surgery (H0) and at 24 hr (H24) and 48 hr (H48) after surgery. We examined the H24 score's associations with both the three-month quality of life, as assessed by the EQ-5D scale, and the number of days spent at home at 30 (DAH30) and 90 (DAH90) days. RESULTS Of the 375 included patients, 352 (94%) completed the QoR-15 at H24 and 338 (90%) were followed up at three months. The population represented the following diverse surgical specialties: orthopedic (51%), gastrointestinal (27%), urologic (13%), and others (9%). The QoR-15 questionnaire confirmed all psychometric qualities (internal consistency, reproducibility, responsiveness, acceptability, construct, and convergent validities) in the emergency context. The average minimum clinical difference was 8.0 at H24. There was an association between QoR-15 at H24 and the three-month quality of life (r = 0.24; 95% confidence interval [CI], 0.14 to 0.34; P < 0.001), DAH30 (r = 0.33; 95% CI, 0.23 to 0.41; P < 0.001), and DAH90 (r = 0.31; 95% CI, 0.22 to 0.40; P < 0.001). CONCLUSION The QoR-15 score is valid for measuring early postoperative recovery after emergency surgery. The H24 score significantly correlated with both the three-month quality of life and the number of days at home. STUDY REGISTRATION ClinicalTrials.gov (NCT04845763); first submitted 11 April 2021.
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Affiliation(s)
- Victoria Le Bescond
- Department of Anesthesia and Intensive Care, Faculty of Health, Angers University Hospital, Angers, France
| | - Jonathan Petit-Phan
- Department of Anesthesia and Intensive Care, Faculty of Health, Angers University Hospital, Angers, France
| | - Maëva Campfort
- Department of Anesthesia and Intensive Care, Faculty of Health, Angers University Hospital, Angers, France
| | - Claire Nicolleau
- Department of Anesthesia and Intensive Care, Faculty of Health, Angers University Hospital, Angers, France
| | - Mathieu Conté
- Department of Anesthesia and Intensive Care, Faculty of Health, Angers University Hospital, Angers, France
| | - Guillaume Bouhours
- Department of Anesthesia and Intensive Care, Faculty of Health, Angers University Hospital, Angers, France
| | - Louis Rony
- Department of Orthopaedics, Angers University Hospital, Angers, France
| | - Sigismond Lasocki
- Department of Anesthesia and Intensive Care, Faculty of Health, Angers University Hospital, Angers, France
| | - Maxime Léger
- Department of Anesthesia and Intensive Care, Faculty of Health, Angers University Hospital, Angers, France.
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, 4th Floor, 521 Parnasses Ave., San Francisco, CA, USA.
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Kahl U, Boehm A, Krause L, Klinger R, Stoimenov K, Zöllner C, Plümer L, Fischer M. Psychometric evaluation of the modified quality of recovery score for the postanaesthesia care unit (QoR-PACU 2)-A prospective validation study. Anaesth Crit Care Pain Med 2024; 43:101380. [PMID: 38499247 DOI: 10.1016/j.accpm.2024.101380] [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: 01/15/2024] [Revised: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND To date, there is no instrument to adequately assess self-reported quality of recovery (QoR) in the post-anesthesia care unit (PACU). We previously developed the QoR-PACU, a 13-item questionnaire specifically applicable to the PACU. The feasibility, acceptance, and validity of the QoR-PACU were promising. However, measures of reliability were slightly lower than expected. METHODS We modified the QoR-PACU and evaluated its psychometric properties in a cohort of adult patients scheduled for non-cardiac surgery with general anesthesia. The modified QoR-PACU (termed QoR-PACU2) was administered before surgery and postoperatively in the PACU at the time of the decision to discharge. RESULTS A total of 307 patients were included in the final analysis. Postoperative QoR-PACU2 sum scores differed across categories of sex, perioperative and surgical risk, and modes of airway management. The duration of anesthesia and surgery, maximum pain intensity and analgesic requirement in the PACU, and length of PACU stay were all inversely correlated with QoR in the PACU. Cronbach's alpha was 0.70 (95%CI: 0.66-0.75). The intra-class correlation coefficient was 0.86 (95%CI: 0.70-0.94, p < 0.001) for intra-rater reliability (n = 24) and 0.94 (95%CI 0.90 to 0.97, p < 0.001) for inter-rater reliability (n = 31). Cohen's effect size was 0.68 and the standardized response mean was 0.57. CONCLUSION The QoR-PACU2 assesses self-reported QoR after surgery in the PACU. Measures of feasibility, validity, and reliability were consistently high. Measures of responsiveness were moderate, which might be attributable to the heterogeneity of the study population. Future studies should include aspects of ethnicity and cross-cultural applicability.
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Affiliation(s)
- Ursula Kahl
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alena Boehm
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Krause
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Regine Klinger
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kaloyan Stoimenov
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Zöllner
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lili Plümer
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Fischer
- Department of Anaesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Bergestuen L, Moger T, Oterhals K, Pfeffer F, Nestvold T, Norderval S, Nymo LS, Havnes K, Lassen K, Breivik K. Translation and validation of the Norwegian version of the postoperative quality of recovery score QoR-15. Acta Anaesthesiol Scand 2024; 68:43-50. [PMID: 37682626 DOI: 10.1111/aas.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 07/20/2023] [Accepted: 08/14/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND As patient-centered care gains more attention, assessing the patient's perspective on their recovery has become increasingly important. In response to the need for a reliable and valid patient reported outcome measurement tool for major surgical resections in Norway. The Norwegian Registry for Gastrointestinal Surgery (NORGAST) initiated a project to translate and evaluate QoR-15's psychometric properties for patients going through general, gastrointestinal (GI), and hepato-pancreato-biliary (HPB) resectional surgery. METHODS After a translation and adaption of the original version of QoR-15 into Norwegian, the QoR-15NO was psychometrically evaluated including a confirmatory factor analysis to test for unidimensionality, as well as tests for content validity, internal consistency, measurement error, construct validity, feasibility, and responsiveness. This process included cognitive interviews using a structured interview guide. Further, patients who underwent various types of GI/HPB surgery at five hospitals in different parts of Norway completed the QoR-15NO before surgery and on the first or second day after surgery. The impact of surgery was classified according to Surgical Outcome Risk Tool v2 (SORT), in extra major/complex, major, intermediate, and minor. RESULTS This study included 324 patients with 83% return rate with both pre- and postoperative forms. There were negative correlations between duration of surgery and postoperative QoR-15 score and the difference between post- and preoperative score (change score). Individuals who had gone through surgery with major impact had a lower postoperative mean QoR-15 score (97) than their counterparts who had experienced either medium (QoR-15: 110) or minor (QoR15: 119) impact surgery. Cronbach's alpha (0.88) and Omega Alpha Total (ωt = 0.90) indicate that the scale has good to very good internal consistency. Test-retest reliability was measured by Intra-class Correlation Coefficient to ICC = 0.70. Confirmatory factor analyses supported that a one-factor model with correlated residuals had a good fit to data. CONCLUSION This study supports QoR-15NO as a valid, essentially unidimensional, feasible, and responsive instrument among patients undergoing general, GI, and HPB resectional surgery in Norway. The total QoR-15NO score provides important information that can be used in an everyday clinical setting and integrated into NORGAST.
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Affiliation(s)
- Linda Bergestuen
- Department of Surgery, Innlandet Hospital Trust, Lillehammer, Norway
| | - Thomas Moger
- Department of Surgery, Innlandet Hospital Trust, Lillehammer, Norway
| | - Kjersti Oterhals
- Centre on Patient-Reported Outcomes, Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Frank Pfeffer
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Torunn Nestvold
- Department of Surgery, Nordland Hospital Trust, Bodø, Norway
| | - Stig Norderval
- Department of Gastrointestinal surgery, University Hospital of North Norway, Tromsø and Institute of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Linn Såve Nymo
- Department of Gastrointestinal surgery, University Hospital of North Norway, Tromsø and Institute of Clinical Medicine, the Arctic University of Norway, Tromsø, Norway
| | - Kjerstin Havnes
- Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Tromsø, Norway
| | - Kristoffer Lassen
- HPB surgery, Oslo university Hospital at Rikshospitalet, Oslo, Norway
| | - Kyrre Breivik
- Centre on Patient-Reported Outcomes, Department of Research and Development, Haukeland University Hospital, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
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Meng F, Baradaran A, Jaberi MM, Tran DQH, Finlayson R, Luc M, Xu L, Thibaudeau S. Patient-Reported Quality of Recovery after Local Anesthesia versus Brachial Plexus Block in Hand Surgery: A Randomized Controlled Study. Plast Reconstr Surg 2023; 152:1287-1296. [PMID: 37189224 DOI: 10.1097/prs.0000000000010688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Both local anesthesia (LA) and brachial plexus (BP) anesthesia are commonly used in hand surgery. LA has increased efficiency and reduced costs, but BP is often favored for more complex hand surgery, despite requiring greater time and resources. The primary objective of this study was to assess the quality of recovery of patients who received LA or BP block for hand surgery. Secondary objectives were to compare postoperative pain and opioid use. METHODS This randomized, controlled, noninferiority study enrolled patients undergoing surgery distal to the carpal bones. Patients were randomized to either LA (wrist or digital block) or BP block (infraclavicular block) before surgery. Patients completed the Quality of Recovery-15 questionnaire on postoperative day (POD) 1. Pain level was assessed with a numeric pain rating scale, and narcotic consumption was recorded on POD1 and POD3. RESULTS A total of 76 patients completed the study (LA, n = 46, BP, n = 30). No statistically significant difference was found for median Quality of Recovery-15 score between LA [127.5 (interquartile range, 28)] and BP block [123.5 (interquartile range, 31)]. The inferiority margin of LA to BP block at the 95% confidence interval was less than the minimal clinically important difference of 8, demonstrating noninferiority of LA compared with BP block. There was no statistically significant difference between LA and BP block for numeric pain rating scale scores or narcotic consumption on POD1 and POD3 ( P > 0.05). CONCLUSION LA is noninferior to BP block for hand surgery with regard to patient-reported quality of recovery, postoperative pain, and narcotic use. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Fanyi Meng
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Aslan Baradaran
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Mehrad Mojtahed Jaberi
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - De Q H Tran
- Department of Anesthesiology, McGill University
| | | | - Mario Luc
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Liqin Xu
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
| | - Stephanie Thibaudeau
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, McGill University Health Centre
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Noll E, De Angelis V, Bopp C, Chauvin C, Talon I, Bennett-Guerrero E, Lefebvre F, Pottecher J. Pictorial adaptation of the quality of recovery 15 scale and psychometric validation into a pediatric surgical population. Sci Rep 2023; 13:14085. [PMID: 37640781 PMCID: PMC10462607 DOI: 10.1038/s41598-023-40673-w] [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: 07/21/2022] [Accepted: 08/16/2023] [Indexed: 08/31/2023] Open
Abstract
Patient reported outcomes measures (PROMS) are important endpoints to measure patient health status in the perioperative setting. However, there are no good tools to measure PROMS in the pediatric surgical population. Patients 7 to 17 years old undergoing surgery were included and followed up for 1 day after surgery (POD1). At POD1 the patients were asked to rate their overall postoperative recovery using a 100-mm visual analog scale (VAS). The primary outcome was the pediatric QoR-15 score on postoperative day 1 (POD1). 150 patients completed the study. The mean (SD) pediatric QoR-15F scores were 132.1 (14.1) and 111.0 (27.0), preoperatively and on POD1, respectively. Convergent validity confirmed with Pearson (r) correlation between the postoperative pediatric QoR-15F and the patient-rated global recovery assessment was 0.72 (95% confidence interval [0.63-0.79]; p < 10-16). Concerning reliability, internal consistency of the pediatric QoR-15 assessed by Cronbach's alpha was 0.90. The test-retest concordance correlation coefficient was 0.92; 95% CI [0.83-0.96]. Split-half alpha was 0.74. The pictorial pediatric version of the QoR-15F showed good validity, reliability, responsiveness, acceptability and feasibility. This PROMS should be considered for clinical care and research in the perioperative pediatric patient setting.Trial Registration: NCT04453410 on clinicaltrials.gov.
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Affiliation(s)
- Eric Noll
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France.
- Physiology Laboratory, Faculté de Médecine, Equipe Acceuil 3072, Strasbourg, France.
| | - Vincent De Angelis
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Claire Bopp
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Chloe Chauvin
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | - Isabelle Talon
- Department of Pediatric Surgery, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
| | | | - François Lefebvre
- Department of Biostatistics, Strasbourg University Hospital, Strasbourg, France
| | - Julien Pottecher
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Hautepierre Hospital, Strasbourg University Hospital, Strasbourg, France
- Physiology Laboratory, Faculté de Médecine, Equipe Acceuil 3072, Strasbourg, France
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KILIÇ Ü, KIYMAZ D, SARAÇOĞLU E, YAZICIOĞLU B. Validity and reliability study of the quality of recovery scale in Turkish. Turk J Med Sci 2023; 53:1144-1154. [PMID: 38813011 PMCID: PMC10763769 DOI: 10.55730/1300-0144.5680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 10/26/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim The aim of this study was to adapt the "Quality of Recovery-15 Scale", developed to measure the postoperative recovery quality of individuals, into Turkish by carrying out validity and reliability studies. Materials and methods This methodological study was conducted with a total of 150 patients who underwent surgery under general anesthesia between November 2021 and January 2022 in a training and research hospital in the Black Sea region. Data was collected from the patients through the face-to-face interview method before the operation, on the 24th and the 48th hour postoperatively. First, the linguistic validity of the scale and then the validity and reliability analyses were carried out. Construct validity, confirmatory factor, and reliability analyses were then performed. Results The Cronbach's alpha coefficient of the scale was 0.851. The Kaiser-Meyer-Olkin test for goodness of fit of the one-dimensional 14-item scale was 0.853 and Bartlett's test was significant. The goodness of fit values of the scale were found to be RMSEA = 0.149, CFI = 0.769, and GFI = 0.745, and they were considered acceptable levels. The eighth item was removed from the scale, which had originally consisted of 15 items, because the item correlation coefficient of this item was <0.200. Conclusion The "Quality of Recovery Scale" was found to be a reliable and valid scale that can be used to measure the quality of recovery after surgery in Turkish society.
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Affiliation(s)
- Ümmühan KILIÇ
- Division of R&D and Projects, Samsun Provincial Health Directorate, Samsun,
Turkiye
| | - Dilek KIYMAZ
- Division of Education and R&D, Samsun Education and Research Hospital, Samsun,
Turkiye
| | - Esra SARAÇOĞLU
- Division of Health Tourism and R&D, Samsun Education and Research Hospital, Samsun,
Turkiye
| | - Bahadır YAZICIOĞLU
- Division of Family Medicine Samsun Education and Research Hospital, Samsun,
Turkiye
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Morales-Ariza V, Loaiza-Aldeán Y, de Miguel M, Peña-Navarro M, Martínez-Silva O, González-Tallada A, Manrique-Muñoz S, de Nadal M. Validation and cross-cultural adaptation of the postoperative quality of recovery 15 (QoR-15) questionnaire for Spanish-speaking patients: A prospective cohort study. Am J Surg 2023; 225:740-747. [PMID: 36414472 DOI: 10.1016/j.amjsurg.2022.11.009] [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: 09/23/2022] [Revised: 11/08/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The postoperative QoR-15 questionnaire may improve the detection of postoperative complications on an early basis and contribute to optimize treatment and recovery. No validated Spanish QoR-15 questionnaire has been available to date. METHODS The Spanish QoR-15 questionnaire (QoR-15E), carried out by official bilingual translators, was administered to 242 adult patients undergoing elective surgery before and 24 h after surgery. Patients were asked about their perceived quality of general recovery using a visual analogue scale (VAS). A random subgroup of 36 patients completed a third questionnaire 30-60 min after having completed the first one, and under the same conditions. RESULTS The Pearson correlation coefficient between QoR-15E and the VAS score was 0.759. Cronbach's alpha was 0.856 in the postoperative period. Reliability by the split-half method was 0.781. Test-retest correlation coefficient was 0.998. Cohen's d was 0.94. The mean time to complete the preoperative questionnaire was 2.9 ± 0.5 min. CONCLUSIONS The QoR-15E is valid and reliable for assessing postoperative quality of recovery in Spanish-speaking patients, with psychometric and interpretative features similar to those of the original instrument.
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Affiliation(s)
- Victor Morales-Ariza
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Yuri Loaiza-Aldeán
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Marcos de Miguel
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Mireia Peña-Navarro
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Olga Martínez-Silva
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Anna González-Tallada
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Susana Manrique-Muñoz
- Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Maternal and foetal medicine Research Group, Vall d'Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Miriam de Nadal
- Department of Surgery, Universitat Autonoma de Barcelona, Unitat Docent Vall d'Hebron, Passeig Vall d'Hebron, 119-129, 08035, Barcelona, Spain; Department of Anaesthesiology and Intensive Care, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain; Neurotraumatology and neurosurgery Research Group, Vall d'Hebron Institut de Recerca (VHIR), Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
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10
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Rosato R, Palazzo V, Borghi F, Camanni M, Puppo A, Delpiano EM, Pellegrino L, Piovano E, Rizzo A, Rolfo M, Morino M, Allaix ME, Testa S, Ciccone G, Pagano E. Factor structure of post-operative quality of recovery questionnaire (QoR-15): An Italian adaptation and validation. Front Psychol 2023; 13:1096579. [PMID: 36817374 PMCID: PMC9936892 DOI: 10.3389/fpsyg.2022.1096579] [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: 11/12/2022] [Accepted: 12/22/2022] [Indexed: 02/04/2023] Open
Abstract
Background The Quality of Recovery questionnaire (QoR-15) is an English instrument for measuring quality of recovery in surgical patients, not yet translated and validated in Italian when the Enhanced Recovery After Surgery (ERAS) Piemonte studies were planned. Objective To produce the Italian version of the QoR-15 questionnaire, to evaluate its factorial structure and to assess the invariance between two types of surgery. Methods The Italian version (QoR-15I) was obtained translating and adapting the original version to the Italian context. The validation was performed suppling the QoR-15I to 3,784 patients enrolled in two parallel stepped wedge cluster randomised trials (ERAS Colon-rectum Piemonte; ERAS Gyneco Piemonte). The factor structure and its invariance between types of surgery was tested using confirmatory bifactor model and multi-group analysis. Comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean square residual (SRMR) fit indices and their changes between nested models were used to assess the factor structure and the invariance. Results The bifactor model showed good fit (RMSEA = 0.049, CFI =0.957, SRMR = 0.036) and provided a general recovery factor and two specific factors for physical and mental recovery. Eighty-four percent of the common variance is attributable to the general factor, and thus the QoR-15I is sufficiently 'one-dimensional' with an adequate reliability (ωh = 0.70). The ωs values for the physical and mental recovery factors were 0.01 and 0.13, respectively. Multigroup analysis supported configural (RMSEA = 0.053, CFI = 0.950, SRMR = 0.035) and metric invariance (ΔRMSEA = -0.004; ΔCFI = -0.002; ΔSRMR = 0.014), whereas the intercept constraint was removed from item 15 to obtain partial scalar invariance (ΔRMSEA = 0.002; ΔCFI = 0.007; ΔSRMR = 0.004). Construct validity was supported by a negative association of QoR-15I scores with all variables related to worse patient condition and more complex surgery. Conclusion Our results support the use of the QoR-15I as a valid, reliable, and clinically feasible tool for measuring the quality of recovery after surgery. The results of the confirmatory factor analyses suggest that a unique recovery score can be calculated and support measurement invariance of the QOR-15I across the two type of surgery, suggesting that the questionnaire has the same meaning and the same measurement parameters in colorectal and gynaecologic patients.
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Affiliation(s)
- Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy,Clinical Epidemiology Unit, Città della Salute e della Scienza Hospital, Torino and CPO Piemonte, Turin, Italy,*Correspondence: Rosalba Rosato, ✉
| | | | - Felice Borghi
- Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS,Turin, Italy
| | - Marco Camanni
- Obstetrics and Gynecology Unit, Martini Hospital – ASL Città di Torino, Turin, Italy
| | - Andrea Puppo
- Obstetrics and Gynecology Unit, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Elena Maria Delpiano
- Obstetrics and Gynecology Unit, Martini Hospital – ASL Città di Torino, Turin, Italy
| | - Luca Pellegrino
- Oncological Surgery, Candiolo Cancer Institute-FPO-IRCCS,Turin, Italy
| | - Elisa Piovano
- Obstetrics and Gynecology Unit 3, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Monica Rolfo
- Healthcare Services Direction, Humanitas, Turin, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | | | - Silvia Testa
- Department of Human and Social Sciences, University of Aosta Valley, Aosta, Italy
| | - Giovannino Ciccone
- Clinical Epidemiology Unit, Città della Salute e della Scienza Hospital, Torino and CPO Piemonte, Turin, Italy
| | - Eva Pagano
- Clinical Epidemiology Unit, Città della Salute e della Scienza Hospital, Torino and CPO Piemonte, Turin, Italy
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11
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Holmström B, Enlund G, Spetz P, Frostell C. The Swedish Perioperative Register: Description, validation of data mapping and utility. Acta Anaesthesiol Scand 2023; 67:233-239. [PMID: 36424870 PMCID: PMC10108284 DOI: 10.1111/aas.14174] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/10/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Since 2013 surgical units in Sweden have reported procedures to the national Swedish Perioperative Register (SPOR). More than four million cases have been documented. Data consist of patient ID, type of surgery, diagnoses, time stamps during the perioperative process (from the decision to operate to the time of discharge from the postoperative recovery area) and quality measures. This article aims to describe SPOR and validate data mapping. Also, we wished to illustrate the utility of the SPOR in assessing variations in national surgical capacity during the COVID-19 pandemia years 2020-2021. METHODS After a detailed description of SPOR, we report on the validation of data performed by comparing data from local databases with data stored in the central SPOR database, assessing missing values and accuracy. Effects of the pandemic on surgical capacity were described by developing an index, based on the number of performed surgical procedures per week during four production weeks in January 2020. Subsequent weeks were then compared with this baseline. RESULTS The validation effort demonstrated nearly 100% data accuracy for the number and type of surgical procedures between local and central data. Missing data was a problem for some parameters. The number of performed surgical procedures decreased dramatically from week 11 in 2020 compared with normal production on a national basis, mainly impairing elective surgery. DISCUSSION Data validation revealed good agreement between local and central databases. The changes in national surgical capacity during the pandemic were illustrated by an index based on the reported surgical production.
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Affiliation(s)
- Björn Holmström
- Department of Medical Technology, Development and Management, Karolinska University Hospital, Stockholm, Sweden
| | - Gunnar Enlund
- Department of Anaesthesia and Intensive Care, Uppsala University Hospital, Uppsala, Sweden
| | - Peter Spetz
- Department of Anaesthesia and Intensive Care, Mälarsjukhuset, Eskilstuna, Sweden
| | - Claes Frostell
- Department of Anaesthesia and Intensive Care, Karolinska Institute at Danderyd Hospital, Stockholm, Sweden
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12
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de Vlieger JCN, Luiting WH, Lockyer J, Meyer P, Fleer J, Sanderman R, Wietasch JKG. Validation of the Dutch translation of the quality of recovery-15 scale. BMC Anesthesiol 2022; 22:243. [PMID: 35915438 PMCID: PMC9341122 DOI: 10.1186/s12871-022-01784-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background The 15-item Quality of Recovery-15 (QoR-15) scale is strongly recommended as a standard patient-reported outcome measure assessing the quality of recovery after surgery and anesthesia in the postoperative period. This study aimed to validate the Dutch translation of the questionnaire (QoR-15NL). Materials and methods An observational, prospective, single-centre cohort study was conducted. Patients who underwent surgery under general anesthesia completed the QoR-15NL (preoperatively (t1) and twice postoperatively (t2 and t3)) and a visual analogue scale (VAS) for general recovery at t2. A psychometric evaluation was performed to assess the QoR-15NL’s validity, reliability, responsiveness, reproducibility and feasibility. Results Two hundred and eleven patients agreed to participate (recruitment rate 94%), and 165 patients were included (completion rate 78%). The QoR-15NL score correlated with the VAS for general recovery (rs = 0.59). Construct validity was further demonstrated by confirmation of expected negative associations between the QoR-15NL and duration of surgery (rs = -0.25), duration of Post Anesthesia Care Unit stay (rs = -0.31), and duration of hospital stay (rs = -0.27). The QoR-15NL score decreased significantly according to the extent of surgery. Cronbach’s alpha was 0.87, split-half reliability was 0.8, and the test–retest intra-class coefficient was 0.93. No significant floor- or ceiling effect was observed. Conclusion The QoR-15NL scale is a valid, easy-to-use, and reliable outcome assessment tool with high responsiveness for patient-reported quality of recovery after surgery and general anesthesia in the Dutch-speaking population. The QoR-15NL’s measurement properties are comparable to the original questionnaire and other translated versions. Trial registration not applicable. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01784-5.
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13
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Brusco NK, Atkinson V, Woods J, Myles PS, Hodge A, Jones C, Lloyd D, Rovtar V, Clifford AM, Morris ME. Implementing PROMS for elective surgery patients: feasibility, response rate, degree of recovery and patient acceptability. J Patient Rep Outcomes 2022; 6:73. [PMID: 35798915 PMCID: PMC9263014 DOI: 10.1186/s41687-022-00483-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) engage patients in co-evaluation of their health and wellbeing outcomes. This study aimed to determine the feasibility, response rate, degree of recovery and patient acceptability of a PROM survey for elective surgery. METHODS We sampled patients with a broad range of elective surgeries from four major Australian hospitals to evaluate (1) feasibility of the technology used to implement the PROMs across geographically dispersed sites, (2) response rates for automated short message service (SMS) versus email survey delivery formats, (3) the degree of recovery at one and four weeks post-surgery as measured by the Quality of Recovery 15 Item PROM (QoR-15), and (4) patient acceptability of PROMS based on survey and focus group results. Feasibility and acceptability recommendations were then co-designed with stakeholders, based on the data. RESULTS Over three months there were 5985 surveys responses from 20,052 surveys (30% response rate). Feasibility testing revealed minor and infrequent technical difficulties in automated email and SMS administration of PROMs prior to surgery. The response rate for the QoR-15 was 34.8% (n = 3108/8919) for SMS and 25.8% (n = 2877/11,133) for email. Mean QoR-15 scores were 122.1 (SD 25.2; n = 1021); 113.1 (SD 27.7; n = 1906) and 123.4 (SD 26.84; n = 1051) for pre-surgery and one and four weeks post-surgery, respectively. One week after surgery, 825 of the 1906 responses (43%) exceeded 122.6 (pre-surgery average), and at four weeks post-surgery, 676 of the 1051 responses (64%) exceeded 122.6 (pre-surgery average). The PROM survey was highly acceptable with 76% (n = 2830/3739) of patients rating 8/10 or above for acceptability. Fourteen patient driven recommendations were then co-developed. CONCLUSION Administering PROMS electronically for elective surgery hospital patients was feasible, acceptable and discriminated changes in surgical recovery over time. Patient co-design and involvement provided innovative and practical solutions to implementation and new recommendations for implementation. Trial Registration and Ethical Approval ACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase III). Ethics approval has been obtained from La Trobe University (Australia) Human Research Ethics Committee (HEC20479). KEY POINTS Patient reported outcome measures (PROMs) help to engage patients in understanding their health and wellbeing outcomes. This study aimed to determine how patients feel about completing a PROM survey before and after elective surgery, and to develop a set of recommendations on how to roll out the survey, based on patient feedback. We found that implementing an electronic PROM survey before and after elective surgery was relatively easy to do and was well accepted by patients. Consumer feedback throughout the project enabled co-design of innovative and practical solutions to PROM survey administration.
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Affiliation(s)
- Natasha K Brusco
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC, Australia
- Alpha Crucis Group, Melbourne, VIC, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, VIC, Australia
| | - Victoria Atkinson
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC, Australia
- Healthscope Limited, Melbourne, VIC, Australia
| | - Jeffrey Woods
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC, Australia
- Healthscope Limited, Melbourne, VIC, Australia
| | - Paul S Myles
- Anaesthesiology and Perioperative Medicine, Central Clinical School, Alfred Hospital and Monash University, Melbourne, VIC, Australia
| | - Anita Hodge
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC, Australia
- Healthscope Limited, Melbourne, VIC, Australia
| | - Cathy Jones
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC, Australia
| | - Damien Lloyd
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC, Australia
- Healthscope Limited, Melbourne, VIC, Australia
| | | | - Amanda M Clifford
- School of Allied Health, Health Research Institute, Ageing Research Centre, University of Limerick, Limerick, Ireland
| | - Meg E Morris
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, VIC, Australia.
- Victorian Rehabilitation Centre, Healthscope Limited, Glen Waverley, VIC, Australia.
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14
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Wessels E, Perrie H, Scribante J, Jooma Z. Quality of recovery in the perioperative setting: A narrative review. J Clin Anesth 2022; 78:110685. [DOI: 10.1016/j.jclinane.2022.110685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 12/30/2022]
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Myles PS, Shulman MA, Reilly J, Kasza J, Romero L. Measurement of quality of recovery after surgery using the 15-item quality of recovery scale: a systematic review and meta-analysis. Br J Anaesth 2022; 128:1029-1039. [DOI: 10.1016/j.bja.2022.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 12/12/2022] Open
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Sellbrant I, Blomstrand J, Karlsson J, Nellgård B, Jakobsson J. Brace versus cast following surgical treatment of distal radial fracture: a prospective randomised study comparing quality of recovery. F1000Res 2022; 10:336. [PMID: 35211291 PMCID: PMC8837810 DOI: 10.12688/f1000research.52046.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Immobilisation following surgical treatment of distal radial fractures (DRF) is traditionally performed with a dorsal cast splint. There is an interest in changing the rigid cast to a removable brace. This can reduce the risk for cast-corrections, complications and improve recovery of function. The aim of the study was to compare quality of recovery (QoR) between brace and traditional cast for immobilisation during the first postoperative week. Methods: 60 patients with American Society of Anesthesiologists (ASA) physical status 1–3, scheduled for surgical treatment of DRF under a supraclavicular block (SCB) in a day-surgery setting were randomised into two groups of immobilisation post-surgery; brace (n=30)
versus traditional cast (n=30). Study objectives were: differences in self-assessed QoR using the QoR-15 questionnaire, postoperative oral oxycodone consumption, perioperative time events and unplanned healthcare contacts one week postoperatively. Results: 54 patients, 46 females/eight males were included in the analysis; 27 with brace and 27 with traditional cast. QoR-15 median scores improved significantly from baseline/preoperative to day 7 (brace p=0.001, cast p=0.001) with no differences between the two groups. The only difference found was that patients in the brace group had significantly worse pain score 24-hours post-surgery (p=0.022). No significant differences were seen in total median oxycodone consumption the
first three postoperative days. No differences were found in perioperative events or unplanned healthcare contacts. Conclusions: Brace appears to be a feasible option to traditional cast for immobilisation following surgical treatment of DRF. The early QoR was similar in both groups apart from more pain in the brace group the first 24 postoperative hours.
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Affiliation(s)
- Irén Sellbrant
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, 431 30, Sweden
| | - Johanna Blomstrand
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, 431 30, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, 431 30, Sweden
| | - Bengt Nellgård
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, 431 30, Sweden
| | - Jan Jakobsson
- Department of Anaesthesia & Intensive Care, Institute of Clinical Science, Karolinska Institute, Danderyd University Hospital, Stockholm, 182 88, Sweden
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17
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Reilly JR, Deng C, Brown WA, Brown D, Gabbe BJ, Hodgson CL, Myles PS. Towards a national perioperative outcomes registry: A survey of perioperative electronic medical record utilisation to support quality assurance and research at Australian and New Zealand College of Anaesthetists Clinical Trials Network hospitals in Australia. Anaesth Intensive Care 2022; 50:189-196. [PMID: 35040352 DOI: 10.1177/0310057x211030284] [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: 11/15/2022]
Abstract
In Australia, 2.7 million surgical procedures are performed annually. Historically, a lack of perioperative data standardisation and infrastructure has limited pooling of routinely collected data across institutions. We surveyed Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network hospitals to investigate current and potential uses of perioperative electronic medical record data for research and quality assurance.A targeted survey was sent to 131 ANZCA Clinical Trials Network-affiliated hospitals in Australia. The primary aim was to map current electronic data collection methods and data utilisation in six domains of the perioperative pathway.The survey response rate was 32%. Electronic data recording in the six domains ranged from 19% to 85%. Where electronic data exist, the ability of anaesthesiology departments to export them for analysis ranged from 27% to 100%. The proportion of departments with access to data exports that are regularly exporting the data for quality assurance or research ranged from 13% to 58%.The existence of a perioperative electronic medical record does not automatically lead to the data being used to measure and improve clinical outcomes. The first barrier is clinician access to data exports. Even when this barrier is overcome, a large gap remains between the proportion of departments able to access data exports and those using the data regularly to inform and improve clinical practice. We believe this gap can be addressed by establishing a national perioperative outcomes registry to lead high-quality multicentre registry research and quality assurance in Australia.
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Affiliation(s)
- Jennifer R Reilly
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Australia.,Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, Australia
| | - Carolyn Deng
- Department of Anaesthesia and Perioperative Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Wendy A Brown
- Department of Surgery, Alfred Health, Melbourne, Australia.,Department of Surgery, Monash University, Melbourne, Australia
| | - Dianne Brown
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Carol L Hodgson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Health, Melbourne, Australia.,Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, Australia
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Shahsavari H, Ghane G, Ghiyasvandian S, Zakerimoghadam M, Najafi F. Psychometric properties of the Persian version of the quality of recovery-15 questionnaire. J Patient Rep Outcomes 2021; 5:108. [PMID: 34689258 PMCID: PMC8542022 DOI: 10.1186/s41687-021-00351-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 08/16/2021] [Indexed: 11/30/2022] Open
Abstract
Background Recovery after surgery is a complex process since it depends on many factors, such as the patient’s sex, age, surgery type, and presence of other diseases. This study aimed to translate and evaluate the psychometric properties of the Persian version of the quality of recovery-15 (QoR-15) questionnaire in Iranian patients undergoing surgery. Methods The Persian version of the QoR-15 questionnaire was developed after translating and culturally validating the instrument. Content validity was assessed with a sample of clinicians (n = 15) and face validity was assessed in a sample of patients (n = 15) undergoing elective surgery. The final questionnaire was completed by 450 patients (n = 450) 24 h after surgery. Construct validity was assessed using exploratory factor analysis in patients (N = 250). Convergence and divergent validity were also assessed. Internal consistency was assessed using Cronbach's alpha and construct reliability was also assessed. Test–retest reliability was assessed on a randomly selected sub sample of 50 patients. Finally, the questionnaire was completed by a further sample of 200 patients 24 h after surgery and construct validity was assessed using confirmatory factor analysis. Results According to Lawshe, all items received at least an acceptable ratio for content validity ratio (CVR). Item content validity index (I-CVI) of each item was greater than 0.79. Construct validity indicated good fit statistics in the five components of CFA, and CFI was > 0.93. The reliability of the QoR-15 questionnaire was acceptable based on Cronbach’s alpha score (> 0.001), test–retest reliability value (0.81), and CR (> 0.7). Conclusion The Persian version of the QoR-15 questionnaire was equivalent to the original one regarding both conceptual and linguistic aspects. This study also confirmed the validity and reliability of the Persian version of the QoR-15 questionnaire. Therefore, the Persian version of the QoR-15 questionnaire can be a suitable and brief instrument to assess the recovery quality in Iranian patients undergoing surgery.
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Affiliation(s)
- Hooman Shahsavari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq., Tehran, Iran
| | - Golnar Ghane
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq., Tehran, Iran.
| | - Shahrzad Ghiyasvandian
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq., Tehran, Iran
| | - Masoumeh Zakerimoghadam
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq., Tehran, Iran
| | - Fatemeh Najafi
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Nosrat St., Tohid Sq., Tehran, Iran
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19
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Morris ME, Brusco N, Woods J, Myles PS, Hodge A, Jones C, Lloyd D, Rovtar V, Clifford A, Atkinson V. Protocol for implementation of the 'AusPROM' recommendations for elective surgery patients: a mixed-methods cohort study. BMJ Open 2021; 11:e049937. [PMID: 34531213 PMCID: PMC8449982 DOI: 10.1136/bmjopen-2021-049937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Incorporating patient-reported outcome measures (PROMs) into usual care in hospitals can improve safety and quality. Gaps exist in electronic PROM (ePROM) implementation recommendations, including for elective surgery. The aims are to: (1) understand barriers and enablers to ePROM implementation in hospitals and develop Australian ePROM implementation recommendations (AusPROM); (2) test the feasibility and acceptability of the Quality of Recovery 15 item short-form (QoR-15) PROM for elective surgery patients applying the AusPROM and (3) establish if the QoR-15 PROM has concurrent validity with the EQ-5D-5L. METHODS AND ANALYSIS Phase I will identify staff barriers and facilitators for the implementation of the AusPROM recommendations using a Delphi technique. Phase II will determine QoR-15 acceptability for elective surgery patients across four pilot hospitals, using the AusPROM recommendations. For phase II, in addition to a consumer focus group, patients will complete brief acceptability surveys, incorporating the QoR-15, in the week prior to surgery, in the week following surgery and 4 weeks postsurgery. The primary endpoint will be 4 weeks postsurgery. Phase III will be the national implementation of the AusPROM (29 hospitals) and the concurrent validity of the QoR-15 and generic EQ-5D-5L. This protocol adopts the Guidelines for Inclusion of Patient-Reported Outcomes in Clinical Trials Protocols guidelines. ETHICS AND DISSEMINATION The results will be disseminated via public forums, conferences and peer-reviewed journals. Ethics approval: La Trobe University (HEC20479). TRIAL REGISTRATION NUMBER ACTRN12621000298819 (Phase I and II) and ACTRN12621000969864 (Phase III).
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Affiliation(s)
- Meg E Morris
- Victorian Rehabilitation Centre, Healthscope Limited, Melbourne, Victoria, Australia
- Academic and Research Collaborative in Health (ARCH), La Trobe University, Bundoora, Victoria, Australia
| | - Natasha Brusco
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Victoria, Australia
| | - Jeffrey Woods
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Paul S Myles
- Anaesthesia and Perioperative Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Anita Hodge
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Cathy Jones
- Healthscope Limited, Melbourne, Victoria, Australia
| | - Damien Lloyd
- Healthscope Limited, Melbourne, Victoria, Australia
| | | | - Amanda Clifford
- School of Allied Health, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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20
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Quality of Recovery Following Orthopedic Surgery in Patients at an Academic Hospital in South Africa. Anesth Analg 2021; 133:507-514. [PMID: 34043308 DOI: 10.1213/ane.0000000000005594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Measurement of perioperative quality of recovery (QoR) is an important tool in improving the patient's perioperative experience. By making use of the Quality of Recovery-15 (QoR-15) questionnaire, this study aimed to measure the QoR on day 1 in patients following elective and semiurgent orthopedic surgery at an academic hospital. A secondary aim was to determine factors that may influence the QoR. METHODS A cross-sectional research study was performed in 122 patients presenting for elective and semiurgent orthopedic surgery during core working hours between July and November 2019 at Helen Joseph Hospital, Johannesburg, South Africa. Patients completed a baseline QoR-15 assessment preoperatively and a day 1 QoR-15 assessment between 12 and 24 hours postoperatively. Additional information on various anesthetic, surgical, and patient factors was collected. RESULTS Nineteen patients (15.6%) had a poor QoR on day 1 and were found to have started with a significantly worse baseline QoR-15 score than those with no poor QoR (98.5 vs 128.5; P < .001). A significant worsening from the overall mean baseline QoR-15 to the overall mean day 1 QoR-15 score was found (123.8 vs 113.1; P = .001). This worsening score was more pronounced in patients with a poor day 1 QoR-15 score than no poor day 1 score (25.3 vs 8; P = .002). Surgical site was found to have a significant effect on day 1 score (P = .026). A significantly worse severe pain score was found in patients with foot/ankle and knee surgery compared to hand/arm surgery (P = .012 and P = .032, respectively) and is thought to be due to the decreased use of peripheral nerve blocks in lower limb surgery. Sex, American Society of Anesthesiologists (ASA) physical status, type of anesthesia, postoperative analgesia, and antiemetic given (only applicable in general anesthetic cases) were not found to have a significant effect on the day 1 QoR-15 scores. CONCLUSIONS Patients who had a poor QoR on day 1 started with a significantly worse baseline QoR-15 score and experienced a significantly greater negative change in the mean difference. Preoperative identification of patients who are at risk of a poor postoperative QoR may aid in preemptive targeting of limited resources to those who need them most. Postoperative pain, particularly in patients after foot/ankle and knee surgery, is a significant modifiable factor to improve postoperative QoR at our institution.
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Nakatani S, Ida M, Tanaka Y, Okamoto N, Wang X, Nakatani H, Sato M, Naito Y, Kawaguchi M. Translation and validation of the Japanese Version of the Quality of Recovery-15 Questionnaire. J Anesth 2021; 35:426-433. [PMID: 33763758 DOI: 10.1007/s00540-021-02921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Patient-reported outcomes after surgery and anaesthesia have recently attracted attention. A recent systematic review and a consensus guideline recommend that patients' recovery can be adequately measured using the quality of recovery-15 (QoR-15) during the perioperative period; however, the Japanese version of the QoR-15 (QoR-15J) is not available. We aimed to translate the QoR-15 into Japanese and assess its validity. METHODS After translating into Japanese, 205 patients who underwent various types of surgery under general anaesthesia were enrolled in the study. QoR-15J was evaluated before surgery and 24 h and 48 h after surgery. Additionally, 30 patients answered the QoR-15J at 25 h after surgery. We assessed the feasibility, reliability, validity, and responsiveness of the QoR-15J. RESULTS One patient who did not undergo surgery and two patients who were discharged within 24 h were excluded. One hundred and eighty-seven patients answered the QoR-15J at 24 h after surgery (completion rate, 92.6%) and 183 patients with complete data were included in the final analysis. The Cronbach's alpha coefficient for internal reliability and Spearman rank correlation coefficient for test-retest reliability were 0.84 and 0.91, respectively. The Cohen effect size for all items was 1.42. CONCLUSIONS QoR-15 was translated into Japanese and the Japanese version's validity was assessed in patients undergoing various types of surgery under general anaesthesia. Our results suggest that QoR-15J is feasible, reliable, valid, and responsive.
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Affiliation(s)
- Shohei Nakatani
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Mitsuru Ida
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan.
| | - Yuu Tanaka
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Naoko Okamoto
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Xiaoying Wang
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Hitomi Nakatani
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Mariko Sato
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Yusuke Naito
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
| | - Masahiko Kawaguchi
- Department of Anaesthesiology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan
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Vignaud M, Morel C, Henault A, Futier E, Pereira B, Lambert C, Beloeil H. Variability and reliability of the French version of the Quality of Recovery-40 Questionnaire (QoR-40). Anaesth Crit Care Pain Med 2021; 40:100822. [PMID: 33722740 DOI: 10.1016/j.accpm.2021.100822] [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: 07/27/2020] [Revised: 10/04/2020] [Accepted: 10/24/2020] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The quality of recovery-40 (QoR-40) is a 40-item questionnaire. It is widely used and validated in English language for non-major surgery. Its objective is to collect information about quality of recovery in the postoperative period. However, a French version of the QoR-40 has not yet been established. The objective of this study was to develop a French version of QoR-40. PATIENTS AND METHODS The translation procedure was established according to Beaton's recommendations to create a French version of QoR-40. One hundred and eighty-one patients were enrolled, and each completed the questionnaire the day after surgery, and 6 h later, and 15 days later. The QoR-40 was compared to morphine consumption in recovery room, and to visual analogue scale. The method of validation for QoR-40 included internal consistency, test-retest reliability, effect size and level of responsiveness. RESULTS Ninety nine per cent of patients answered the full questionnaire at day one. Cronbach's alpha for the global QoR-40 at day one was 0.83. For the total QR40 total score, Lin's concordance coefficient was 0.78 (95% CI [0.70; 0.86]). The sensitivity to change was determined in 39 patients for an effect-size equals 0.56 (95% CI [0.11; 1.02]). CONCLUSION The French version of QoR-40 seems to be valid, reliable, and acceptable as the original English version.
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Affiliation(s)
- Marie Vignaud
- Département d'Anesthésie et Réanimation, Centre Hospitalier Universitaire (CHU) Clermont Ferrand, Hôpital Estaing, 63100 Clermont-Ferrand, France.
| | - Cloé Morel
- Département d'Anesthésie et Réanimation, Centre Hospitalier Universitaire (CHU) Clermont Ferrand, Hôpital Estaing, 63100 Clermont-Ferrand, France
| | - Antoine Henault
- Département d'Anesthésie et Réanimation, Centre Hospitalier Universitaire (CHU) Rennes, France
| | - Emmanuel Futier
- Département d'Anesthésie et Réanimation, Centre Hospitalier Universitaire (CHU) Clermont Ferrand, Hôpital Estaing, and Université Clermont-Auvergne, CNRS, INSERM U-1103, 63000 Clermont Ferrand, France
| | - Bruno Pereira
- Biostatistic Unit, Centre Hospitalier Universitaire (CHU) Clermont Ferrand, Direction de la Recherche Clinique et de l'Innovation (DCRI), 63100 Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistic Unit, Centre Hospitalier Universitaire (CHU) Clermont Ferrand, Direction de la Recherche Clinique et de l'Innovation (DCRI), 63100 Clermont-Ferrand, France
| | - Hélène Beloeil
- Département d'Anesthésie et Réanimation, Centre Hospitalier Universitaire (CHU) Rennes, France; Rennes University, INSERM, INRA, Rennes University Hospital, CIC 1414, Rennes, France
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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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Lee JH, Ki M, Choi S, Woo CJ, Kim D, Lim H, Kim DC. Validity and reliability of the Korean version of the Quality of Recovery-15 questionnaire. Korean J Anesthesiol 2020; 74:142-149. [PMID: 33121227 PMCID: PMC8024207 DOI: 10.4097/kja.20435] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
Background The quality of recovery-40 questionnaire (QoR-40) has been widely used to assess quality of recovery after surgery, but it is too lengthy for clinical use. The short form of QoR-40, QoR-15, has been validated in many languages; however, an official Korean version of the QoR-15 (QoR-15K) has not yet been established. This study aimed to develop and validate QoR-15K. Methods Based on the previously-validated Korean QoR-40, we selected 15 items; the QoR-15K was patterned on the original QoR-15. We analyzed 210 subjects who had been scheduled for elective surgery under general anesthesia. The patients completed the questionnaire before surgery and on postoperative days one and two. The validity, reliability, and responsiveness of the QoR-15K were evaluated. Results We obtained excellent convergent validity on visual analog scale for recovery (ρ = 0.882, P < 0.001). The duration of anesthesia, post-anesthesia care unit, and overall hospital stay with the QoR-15K showed a significant negative correlation (ρ = −0.183, −0.151, and −0.185, respectively). Cronbach’s α was 0.909. Cohen’s effect size and standardized response mean were 0.819 and 0.721. The recruitment and completion rate were 92.9% and 100%, respectively. We based the above calculations on the results obtained on the first day following surgery. Conclusions The validity and reliability of the QoR-15K are comparable to those of the English version. The QoR-15K would be a good instrument to assess the quality of recovery in Korean patients after surgery.
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Affiliation(s)
- Jun Ho Lee
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Minjong Ki
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Seungseo Choi
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Cheol Jong Woo
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Deokkyu Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Hyungsun Lim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Dong-Chan Kim
- Department of Anesthesiology and Pain Medicine, Chonbuk National University Medical School and Hospital, Jeonju, Korea
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Moraitis A, Hultin M, Walldén J. Risk of postoperative nausea and vomiting in hip and knee arthroplasty: a prospective cohort study after spinal anaesthesia including intrathecal morphine. BMC Anesthesiol 2020; 20:242. [PMID: 32972366 PMCID: PMC7517815 DOI: 10.1186/s12871-020-01154-z] [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: 04/02/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The overall risk of postoperative nausea and vomiting after general anaesthesia is approximately 30% even with prophylactic medications. Studies exploring the risk after regional anaesthesia including intrathecal morphine are limited but indicate that intrathecal morphine is highly emetogenic and is additive to the PONV risk associated with other forms of anaesthesia. The aim of this observational study was to investigate the risk of PONV after spinal blockade combined with intrathecal morphine and to explore associations with patient and perioperative factors, including given PONV-prophylaxis. We hypothesized that a large number of patients in a clinical setting receive less prophylaxis than the recommendations in guidelines (suboptimal prophylaxis), leading to a higher risk for PONV compared to those receiving adequate PONV prophylaxis. METHODS The study was conducted as a prospective observational cohort study regarding PONV in patients undergoing hip/knee replacement under spinal anaesthesia including intrathecal morphine. Patients were included at a county hospital in Sweden during April-November 2013 (n = 59) and September 2014-June 2015 (n = 40). One hundred eight patients entered the study with 99 patients analysed in the final cohort. Patients were followed the first three postoperative days with a questionnaire regarding PONV and peri- and postoperative data was collected. PONV risk is presented as the proportion of patients (%) with PONV and was related to the level of perioperative PONV-prophylaxis (suboptimal/optimal). Univariate analysis was used to analyse factors associated with PONV. RESULTS Forty-six patients (46%) experienced PONV during the 3-day study period whereof 36 patients (36%) until noon the first day after the procedure. 19/27 patients (70%) that received suboptimal PONV-prophylaxis experienced PONV compared to 27/72 (38%) that received optimal PONV-prophylaxis (p = 0.015). Further, female gender and/or a history of motion sickness were associated with an increased PONV-risk. CONCLUSIONS There was a high risk for PONV after spinal anaesthesia including morphine. PONV risk was associated with the level of prophylaxis and with known risk factors for PONV. Our findings suggest that a more liberal use of PONV prophylaxis might be motivated.
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Affiliation(s)
- Antonio Moraitis
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Sundsvall, Sweden.
| | - Magnus Hultin
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Umeå), Umeå University, Umeå, Sweden
| | - Jakob Walldén
- Department of Surgical and Perioperative Sciences, Anaesthesiology and Intensive Care Medicine (Sundsvall), Umeå University, Sundsvall, Sweden
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Yoon S, Joo H, Oh YM, Lee J, Bahk JH, Lee HJ. Validation and clinical utility of the Korean version of the Quality of Recovery-15 with enhanced recovery after surgery: a prospective observational cohort study. Br J Anaesth 2020; 125:614-621. [PMID: 32703550 DOI: 10.1016/j.bja.2020.06.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/11/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The 15-item Quality of Recovery (QoR-15) scale is a validated patient-reported outcome questionnaire that measures the quality of postoperative recovery. This study aimed to validate a translated Korean version of QoR-15 (QoR-15K) in a broad range of surgical patients. METHODS After Korean translation of the original English version of the QoR-15, we performed psychometric validation of the QoR-15K to evaluate the quality of recovery after surgery. The validity, reliability, responsiveness, and clinical feasibility of the QoR-15K were evaluated. A subgroup analysis in patients with video-assisted lung resection was performed. RESULTS Among 193 patients, 188 (97.4%) completed the QoR-15K after surgery. We found good convergent validity between the postoperative QoR-15K and the global QoR visual analogue scale (ρ=0.61, P<0.001). The negative correlation between the QoR-15K score and the extent of surgery (ρ=-0.33, P<0.001), the duration of surgery (ρ=-0.33, P<0.001), and the severity of postoperative pain (ρ=-0.40, P<0.001) supported construct validity. The postoperative QoR-15K showed good internal consistency (Cronbach α=0.90), split-half reliability (0.81), and test-retest reliability (0.95; 95% confidence interval [CI], 0.94-0.96). The QoR-15K score decreased from 140 (preoperative, inter-quartile range [IQR] 128-146) to 100 (postoperative day 1, IQR 75-122), median difference -36.5 (95% CI, -41 to -32.5; P<0.0001). The QoR-15K indicated excellent responsiveness with Cliff's effect size -0.78 (95% CI, -0.84 to -0.71). Subgroup analysis yielded similar results. CONCLUSIONS The QoR-15K is valid and has excellent reliability, a high degree of responsiveness, and clinical feasibility as a metric of quality of recovery in Korean surgical population. CLINICAL TRIAL REGISTRATION NCT04169087.
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Affiliation(s)
- Susie Yoon
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyundeok Joo
- Seoul National University College of Medicine, Seoul, South Korea
| | - Yoo Min Oh
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jihye Lee
- Occupational Safety and Health Research Institute, Incheon, South Korea
| | - Jae-Hyon Bahk
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Ho-Jin Lee
- Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, South Korea; Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea.
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The Impact of Preoperative Patient Anxiety on Postoperative Anxiety and Quality of Recovery After Orthopaedic Surgery. J Perianesth Nurs 2020; 35:260-264. [DOI: 10.1016/j.jopan.2019.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/07/2019] [Accepted: 11/25/2019] [Indexed: 12/25/2022]
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Demumieux F, Ludes PO, Diemunsch P, Bennett-Guerrero E, Lujic M, Lefebvre F, Noll E. Validation of the translated Quality of Recovery-15 questionnaire in a French-speaking population. Br J Anaesth 2020; 124:761-767. [DOI: 10.1016/j.bja.2020.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/26/2020] [Accepted: 03/14/2020] [Indexed: 12/18/2022] Open
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Myles PS. More than just morbidity and mortality – quality of recovery and long‐term functional recovery after surgery. Anaesthesia 2020; 75 Suppl 1:e143-e150. [DOI: 10.1111/anae.14786] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2019] [Indexed: 12/23/2022]
Affiliation(s)
- P. S. Myles
- Department of Anaesthesiology and Peri‐operative Medicine Alfred Hospital and Monash University Melbourne Vic. Australia
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Tan NL, Gotmaker R, Barrington MJ. Impact of Local Infiltration Analgesia on the Quality of Recovery After Anterior Total Hip Arthroplasty: A Randomized, Triple-Blind, Placebo-Controlled Trial. Anesth Analg 2019; 129:1715-1722. [PMID: 31743193 DOI: 10.1213/ane.0000000000004255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Local infiltration analgesia (LIA) is commonly used in anterior total hip arthroplasty (THA) surgery; however, evidence for its efficacy is lacking. We hypothesized that LIA with 0.2% ropivacaine when compared with injection of placebo (0.9% saline) would improve patient quality of recovery on postoperative day (POD) 1, as measured by the Quality of Recovery-15 (QoR-15) score. METHODS Patients scheduled to have a primary unilateral anterior THA with a single surgeon in a tertiary level metropolitan hospital were randomized to receive LIA with either 2.5 mL/kg of 0.2% ropivacaine or 0.9% saline as placebo. Patients and clinical and study personnel were blinded to group allocation. Perioperative care was standardized and this included spinal anesthesia and oral multimodal analgesia. The primary outcome was a multidimensional (pain, physical comfort, physical independence, emotions, and psychological support) patient-reported quality of recovery scale, QoR-15, measured on POD 1. RESULTS One hundred sixty patients were randomized; 6 patients were withdrawn after randomization and 2 patients had incomplete outcome data. The intention-to-treat analysis included 152 patients. The median (interquartile range [IQR]) QoR-15 score on POD 1 of the ropivacaine group was 119.5 (102-124), compared with the placebo group which had a median (IQR) of 115 (98-126). The median difference of 2 (95% confidence interval [CI], -4 to 7; P = .56) was not statistically or clinically significant. An as-per-protocol sensitivity analysis of 146 patients who received spinal anesthesia without general anesthesia, and the allocated intervention, also showed no evidence of a significant difference between groups. Secondary outcomes (worst pain numerical rating scale at rest and with movement on POD 1, opioid consumption on PODs 1 and 2, mobilization on POD 1, Brief Pain Inventory severity and interference on POD 90, and length of stay) were similar in both groups. CONCLUSIONS LIA with 0.2% ropivacaine when compared with 0.9% saline as placebo did not improve quality of recovery 1 day after anterior THA.
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Affiliation(s)
- Nicole L Tan
- From the Department of Anaesthesia, Critical Care Institute, Epworth HealthCare, Melbourne, Australia
- Department of Medicine and Radiology, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Robert Gotmaker
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
| | - Michael J Barrington
- Department of Anaesthesia and Acute Pain Medicine, St Vincent's Hospital, Melbourne, Australia
- Department of Medicine and Radiology, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
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Öbrink E, Lerström J, Hillström C, Oddby E, Jakobsson JG. Can simple perioperative measures improve quality of recovery following ambulatory laparoscopic surgery in females? An open prospective randomised cohort study, comparing nutritional preoperative drink and chewing gum during recovery to standard care. Ann Med Surg (Lond) 2019; 44:20-25. [PMID: 31289670 PMCID: PMC6593201 DOI: 10.1016/j.amsu.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/24/2019] [Indexed: 12/04/2022] Open
Abstract
One major goal in modern perioperative anaesthesia care is to facilitate a rapid, yet safe recovery process, with focus on improving time to regained consciousness and subsequent resuming of activities of daily living. Laparoscopic cholecystectomy and gynaecological laparoscopy are a “high volume” procedure commonly performed in young females expecting rapid resumption of health. The aim of this study was to assess whether it was possible to improve patients’ self-assessed quality of recovery in female patient undergoing laparoscopic cholecystectomy by simple perioperative measures in the form of a preoperative 200 ml nutritional drink and chewing gum during early recovery. Methods Patients were randomised to an active group receiving the intervention, and controls provided with standard care only. Patients were followed by questionnaire interviews preoperatively and at 2, 24 and 48 h after surgery. The Quality of Recovery scale (QoR) 15 items and 5 additional questions around gastro-intestinal symptoms were self-assessed by patients at each occasion. Result Seventy-three ASA 1–2 female patients’ undergoing elective laparoscopic surgery were included, surgery and anaesthesia was uneventful. The QoR score was significantly higher both at 24 and 48 h, 113 SD 20 vs 101 SD 25 (p = 0.026) and 123 SD 13 vs 111 SD 13 (p = 0.006) in the active group of patients as compared to controls. Conclusion Simply providing 200 ml nutritional preoperative drink and chewing gum during recovery was found effective, improving patients assessed quality of recovery. One major goal in modern perioperative anaesthesia care is to facilitate a rapid, yet safe recovery process. Simply providing 200 ml nutritional preoperative drink and chewing gum during recovery was found effective, improving patients self-assessed quality of recovery. Quality of recovery, assessed by a multi dimensional tool (QoR15), in females after laparoscopic surgery is still not complete 48 h after surgery.
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Affiliation(s)
- Emma Öbrink
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Johanna Lerström
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Christian Hillström
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Eva Oddby
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Jan G Jakobsson
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
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Marinho R, Lusquinhos J, Carvalho B, Azevedo J, Santos A, Abelha F. Quality of recovery after surgery for cancer treatment. ACTA ACUST UNITED AC 2018; 65:426-433. [PMID: 30297034 DOI: 10.1016/j.redar.2018.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/11/2018] [Accepted: 04/22/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Assessment of quality of recovery is important as an end-point for outcome research. This study aims to determine the incidence and determinants of poor quality of recovery (PQR) after surgery in patients scheduled for curative neoplastic surgery. MATERIALS AND METHODS An observational prospective study was performed in consecutive patients undergoing surgery for cancer treatment. The Quality of Recovery 15 score (QoR-15) was applied on the day before surgery (T0) and 24h after (T1). PQR was defined for patients with a QoR-15 score lower than the mean QoR-15 score at T1 minus one standard deviation. Preoperative quality of life was assessed with EuroQol-5D. Frailty and disability were defined using Clinical Frailty Scale and World Health Organization Disability Assessment Schedule 2.0. RESULTS One hundred and thirty-eight patients were enrolled and 31 (15.9%) were identified as having PQR. At T0, patients with PQR presented lower scores on total QoR-15 (P=.03) and had more problems on EuroQol-5D in mobility (P=.014), self-care (P=.027) and usual activities domains (P=.019). The difference of QoR-15 score between T1 and T0 was higher in PQR patients (P<.001). PQR had more frequently Revised Cardiac Risk Index (RCRI)≥2 (P=.012) and were more frequently frail (P=.03). PQR patients stayed longer in the hospital (P=.034). CONCLUSION PQR patients had lower QoR-15 before surgery, poor quality of life, were more frequently frail and had high cardiac risk factors. PQR patients stayed longer in the hospital.
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Affiliation(s)
- R Marinho
- Department of Anesthesiology, Centro Hospitalar São João, , Porto, Portugal.
| | - J Lusquinhos
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - B Carvalho
- Department of Anesthesiology, Centro Hospitalar São João, , Porto, Portugal
| | - J Azevedo
- Department of Anesthesiology, Centro Hospitalar São João, , Porto, Portugal
| | - A Santos
- Department of Anesthesiology, Centro Hospitalar São João, , Porto, Portugal
| | - F Abelha
- Department of Anesthesiology, Centro Hospitalar São João, , Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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