title: Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults.
abstract: A variety of methods have been used to quantify aspects of recovery after anesthesia. Most are narrowly focused, are not patient-rated, and have not been validated. We therefore set out to develop a patient-rated quality of recovery score. We constructed a 61-item questionnaire that asked individuals (patients and relatives, medical and nursing staff; total n = 136) to rate various postoperative items describing features a patient may experience postoperatively. The most highly ranked items were included in a final nine-point index score, which we called the "QoR Score." We then studied two cohorts of surgical patients (n = 449). There was good convergent validity between the QoR Score and the visual analog scale score (rho = 0.55, P < 0.0001). Discriminant construct validity was supported by comparing resultant QoR Scores in patients undergoing day-stay, minor, and major surgery (P = 0.008), as well as a negative correlation with duration of hospital stay (rho = -0.20, P < 0.0001), and, using multivariate regression, demonstrating a significant negative relationship between QoR Score and female gender (P = 0.048) and older age (P = 0.041). There was also good interrater agreement (rho = 0.55, P < 0.0001), test-retest reliability (median rho = 0.61, P < 0.0001), and internal consistency (alpha = 0.57 and 0.90, P < 0.0001). There was a significant difference between the groups of patients recovering from major and minor surgery (P < 0.001). This study demonstrates that the QoR Score has good validity, reliability, and clinical acceptability in patients undergoing many types of surgery.
  
  
  CONCLUSIONS
  We set out to develop a patient-rated quality of recovery score (QoR) that could be used both as a measure of outcome in perioperative trials and for clinical audit. We first surveyed patients and staff to identify important aspects of recovery, then developed a nine-point QoR Score. This was then compared with other measures of postoperative outcome. We found that the QoR Score is a useful measure of recovery after anesthesia and surgery.
authors.affiliation: Department of Anaesthesia and Pain Management, Alfred Hospital, Victoria, Australia. p.myles@alfred.org.au
authors.forename: P S
authors.initials: PS
authors.lastname: Myles
authors.forename: J O
authors.initials: JO
authors.lastname: Hunt
authors.forename: C E
authors.initials: CE
authors.lastname: Nightingale
authors.forename: H
authors.initials: H
authors.lastname: Fletcher
authors.forename: T
authors.initials: T
authors.lastname: Beh
authors.forename: D
authors.initials: D
authors.lastname: Tanil
authors.forename: A
authors.initials: A
authors.lastname: Nagy
authors.forename: A
authors.initials: A
authors.lastname: Rubinstein
authors.forename: J L
authors.initials: JL
authors.lastname: Ponsford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011594:Psychometrics / Q000379:methods*; D011788:Quality of Life; D015203:Reproducibility of Results; D013514:Surgical Procedures, Operative / Q000379:methods*; D011795:Surveys and Questionnaires