Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults

A variety of methods have been used to quantify aspects of recovery after a nesthesia. Most are narrowly focused, are not patient-rated, and have not b een validated. We therefore set out to develop a patient-rated quality of r ecovery score. We constructed a 61-item questionnaire that asked individual s (patients and relatives, medical and nursing staff; total n = 136) to rat e 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 co horts of surgical patients (n = 449). There was good convergent validity be tween the QoR Score and the visual analog scale score (rho = 0.55, P < 0.00 01). Discriminant construct validity was supported by comparing resultant Q oR 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 fro m major and minor surgery (P < 0.001). This study demonstrates that the QoR Score has good validity, reliability, and clinical acceptability in patien ts undergoing many types of surgery. Implications: We set out to develop a patient-rated quality of recovery score (QoR) that could be used both as a measure of outcome in perioperative trials and for clinical audit. We first surveyed patients and staff to identify important aspects of recovery, the n developed a nine-point QoR Score. This was then compared with other measu res of postoperative outcome. We found that the QoR Score is a useful measu re of recovery after anesthesia and surgery.