Psychometric evaluation of a quality of recovery score for the postanesthesia care unit-A preliminary validation study

Ursula Kahl; Katrin Brodersen; Sarah Kaiser; Linda Krause; Regine Klinger; Lili Plümer; Christian Zöllner; Marlene Fischer

doi:10.1371/journal.pone.0289685

Psychometric evaluation of a quality of recovery score for the postanesthesia care unit-A preliminary validation study

PLoS One. 2023 Aug 15;18(8):e0289685. doi: 10.1371/journal.pone.0289685. eCollection 2023.

Authors

Ursula Kahl¹, Katrin Brodersen¹, Sarah Kaiser¹, Linda Krause², Regine Klinger¹, Lili Plümer¹, Christian Zöllner¹, Marlene Fischer^{1

3}

Affiliations

¹ Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
³ Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Abstract

Introduction: Patients' perception of postoperative recovery is a key aspect of perioperative care. Self-reported quality of recovery (QoR) has evolved as a relevant endpoint in perioperative research. Several psychometric instruments have been introduced to assess self-reported recovery 24 hours after surgery. However, there is no questionnaire suitable for use in the postanesthesia care unit (PACU). We aimed to develop and psychometrically evaluate a QoR questionnaire for the PACU (QoR-PACU).

Methods: The QoR-PACU was developed in German language based on the 40-item QoR-40 questionnaire. Between March and November 2020, adult patients scheduled for elective urologic surgery completed the QoR-PACU preoperatively and during the PACU stay. We evaluated feasibility, validity, reliability, and responsiveness.

Results: We included 375 patients. After two piloting phases including 72 and 48 patients, respectively, we administered the final version of the QoR-PACU to 255 patients, with a completion rate of 96.5%. Patients completed the QoR-PACU at a median of 125.0 (83.0; 156.8) min after arrival in the PACU. Construct validity was good with postoperative QoR-PACU sum scores correlating with age (r = 0.23, 95% CI: 0.11 to 0.35, p < 0.001), length of PACU stay (r = -0.15, 95%CI: -0.27 to -0.03, p = 0.02), pain in the PACU (r = -0.48, 95% CI: -0.57 to -0.37, p < 0.001) and piritramide dose administered (r = -0.29, 95% CI: -0.40 to -0.17, p < 0.001). Cronbach's alpha was 0.67 (95% CI: 0.61-0.73) with moderate test-retest reliability (ICC of 0.67, 95% CI: 0.38 to 0.83). Cohen's effect size was 3.08 and the standardized response mean was 1.65 indicating adequate responsiveness.

Conclusion: The assessment of QoR in the early postoperative period is feasible. We found high acceptability, good validity, adequate responsiveness, and moderate reliability. Future studies should evaluate the psychometric properties of the QoR-PACU in more heterogeneous patient populations including female and gender-diverse patients with varying degress of perioperative risk.

Copyright: © 2023 Kahl et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anesthesia Recovery Period*
Female
Humans
Psychometrics
Reproducibility of Results
Self Report
Surveys and Questionnaires

Grants and funding

Ursula Kahl was funded by the Clinician Scientist Program of the medical faculty of the University of Hamburg, during the conduct of the study. The University of Hamburg was not involved in any of the following: study design, conduct of the research, preparation of this manuscript, analysis and interpretation of data; writing of the report; decision to submit the article for publication.