Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15.
TL;DR: The QoR-15 provides a valid, extensive, and yet efficient evaluation of postoperativeQoR, and is suitable for clinical and research evaluation of quality of recovery after anesthesia.
Abstract: BACKGROUND Quality of recovery (QoR) after anesthesia is an important measure of the early postoperative health status of patients The aim was to develop a short-form postoperative QoR score, and test its validity, reliability, responsiveness, and clinical acceptability and feasibility METHODS Based on extensive clinical and research experience with the 40-item QoR-40, the strongest psychometrically performing items from each of the five dimensions of the QoR-40 were selected to create a short-form version, the QoR-15 This was then evaluated in 127 adult patients after general anesthesia and surgery RESULTS There was good convergent validity between the QoR-15 and a global QoR visual analog scale (r = 068, P < 00005) Construct validity was supported by a negative correlation with duration of surgery (r = -049, P < 00005), time spent in the postanesthesia care unit (r = -041, P < 00005), and duration of hospital stay (r = -053, P < 00005) There was also excellent internal consistency (085), split-half reliability (078), and test-retest reliability (ri = 099), all P < 00005 Responsiveness was excellent with an effect size of 135 and a standardized response mean of 104 The mean ± SD time to complete the QoR-15 was 24 ± 08 min CONCLUSIONS The QoR-15 provides a valid, extensive, and yet efficient evaluation of postoperative QoR
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TL;DR: Among patients at increased risk for complications during major abdominal surgery, a restrictive fluid regimen was not associated with a higher rate of disability‐free survival than a liberal fluid regimen and was associated with an increased rate of acute kidney injury.
Abstract: Background Guidelines to promote the early recovery of patients undergoing major surgery recommend a restrictive intravenous-fluid strategy for abdominal surgery. However, the supporting evidence is limited, and there is concern about impaired organ perfusion. Methods In a pragmatic, international trial, we randomly assigned 3000 patients who had an increased risk of complications while undergoing major abdominal surgery to receive a restrictive or liberal intravenous-fluid regimen during and up to 24 hours after surgery. The primary outcome was disability-free survival at 1 year. Key secondary outcomes were acute kidney injury at 30 days, renal-replacement therapy at 90 days, and a composite of septic complications, surgical-site infection, or death. Results During and up to 24 hours after surgery, 1490 patients in the restrictive fluid group had a median intravenous-fluid intake of 3.7 liters (interquartile range, 2.9 to 4.9), as compared with 6.1 liters (interquartile range, 5.0 to 7.4) in 149...
532 citations
TL;DR: Standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research were developed and four composite outcome measures were identified, which were designed to evaluate postoperative outcomes.
Abstract: There is a need for large trials that test the clinical effectiveness of interventions in the field of perioperative medicine. Clinical outcome measures used in such trials must be robust, clearly defined and patient-relevant. Our objective was to develop standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research. A literature search was conducted using PubMed and opinion leaders worldwide were invited to nominate papers that they believed the group should consider. The full texts of relevant articles were reviewed by the taskforce members and then discussed to reach a consensus on the required standards. The report was then circulated to opinion leaders for comment and review. This report describes definitions for 22 individual adverse events with a system of severity grading for each. In addition, four composite outcome measures were identified, which were designed to evaluate postoperative outcomes. The group also agreed on standards for four outcome measures for the evaluation of healthcare resource use and quality of life. Guidance for use of these outcome measures is provided, with particular emphasis on appropriate duration of follow-up. This report provides clearly defined and patient-relevant outcome measures for large clinical trials in perioperative medicine. These outcome measures may also be of use in clinical audit. This report is intended to complement and not replace other related work to improve assessment of clinical outcomes following specific surgical procedures.
517 citations
TL;DR: Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain,Use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery.
Abstract: Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative ...
238 citations
TL;DR: Perioperative interventions that result in a change of 0.9 for the QoR score, 8.0 for theQoR-15, or 6.3 for the X-ray image quality signify a clinically important improvement or deterioration.
Abstract: Background:Several quality of recovery (QoR) health status scales have been developed to quantify the patient’s experience after anesthesia and surgery, but to date, it is unclear what constitutes the minimal clinically important difference (MCID) That is, what minimal change in score would indicat
234 citations
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TL;DR: An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
43,884 citations
"Development and psychometric evalua..." refers background in this paper
...7) Any major complication 23 (18) Timing of assessment after surgery, h Mean ± SD 26 ± 4....
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...Other 42 (33) Any medical condition 103 (81) ASA physical status I 19 (15) II 50 (39) III 40 (32) IV 18 (14) Extent of surgery Ambulatory or other minor 21 (17) Intermediate 42 (33) Major 64 (50) Type of surgery Cardiothoracic 25 (20) General 23 (18) Orthopedic 22 (17) Neurosurgical 20 (16) Vascular 13 (10) Plastics 12 (9....
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TL;DR: In this paper, a general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of all split-half coefficients resulting from different splittings of a test, therefore an estimate of the correlation between two random samples of items from a universe of items like those in the test.
Abstract: A general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of all split-half coefficients resulting from different splittings of a test. α is therefore an estimate of the correlation between two random samples of items from a universe of items like those in the test. α is found to be an appropriate index of equivalence and, except for very short tests, of the first-factor concentration in the test. Tests divisible into distinct subtests should be so divided before using the formula. The index
$$\bar r_{ij} $$
, derived from α, is shown to be an index of inter-item homogeneity. Comparison is made to the Guttman and Loevinger approaches. Parallel split coefficients are shown to be unnecessary for tests of common types. In designing tests, maximum interpretability of scores is obtained by increasing the first-factor concentration in any separately-scored subtest and avoiding substantial group-factor clusters within a subtest. Scalability is not a requisite.
37,235 citations
"Development and psychometric evalua..." refers background in this paper
...Other 42 (33) Any medical condition 103 (81) ASA physical status I 19 (15) II 50 (39) III 40 (32) IV 18 (14) Extent of surgery Ambulatory or other minor 21 (17) Intermediate 42 (33) Major 64 (50) Type of surgery Cardiothoracic 25 (20) General 23 (18) Orthopedic 22 (17) Neurosurgical 20 (16) Vascular 13 (10) Plastics 12 (9....
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TL;DR: Twenty cross-sectional and longitudinal tests of empirical validity previously published for the 36-item short-form scales and summary measures were replicated for the 12-item Physical Component Summary and the12-item Mental Component Summary, including comparisons between patient groups known to differ or to change in terms of the presence and seriousness of physical and mental conditions.
Abstract: Regression methods were used to select and score 12 items from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) to reproduce the Physical Component Summary and Mental Component Summary scales in the general US population (n=2,333). The resulting 12-item short-form (SF-12) achieved multiple R squares of 0.911 and 0.918 in predictions of the SF-36 Physical Component Summary and SF-36 Mental Component Summary scores, respectively. Scoring algorithms from the general population used to score 12-item versions of the two components (Physical Components Summary and Mental Component Summary) achieved R squares of 0.905 with the SF-36 Physical Component Summary and 0.938 with SF-36 Mental Component Summary when cross-validated in the Medical Outcomes Study. Test-retest (2-week)correlations of 0.89 and 0.76 were observed for the 12-item Physical Component Summary and the 12-item Mental Component Summary, respectively, in the general US population (n=232). Twenty cross-sectional and longitudinal tests of empirical validity previously published for the 36-item short-form scales and summary measures were replicated for the 12-item Physical Component Summary and the 12-item Mental Component Summary, including comparisons between patient groups known to differ or to change in terms of the presence and seriousness of physical and mental conditions, acute symptoms, age and aging, self-reported 1-year changes in health, and recovery for depression. In 14 validity tests involving physical criteria, relative validity estimates for the 12-item Physical Component Summary ranged from 0.43 to 0.93 (median=0.67) in comparison with the best 36-item short-form scale. Relative validity estimates for the 12-item Mental Component Summary in 6 tests involving mental criteria ranged from 0.60 to 107 (median=0.97) in relation to the best 36-item short-form scale. Average scores for the 2 summary measures, and those for most scales in the 8-scale profile based on the 12-item short-form, closely mirrored those for the 36-item short-form, although standard errors were nearly always larger for the 12-item short-form.
14,793 citations
TL;DR: The criteria can be used in systematic reviews of health status questionnaires, to detect shortcomings and gaps in knowledge of measurement properties, and to design validation studies.
7,439 citations