Bowyer Andrea, Royse Colin F
aDepartment of Anaesthesia and Pain Management, Royal Melbourne Hospital bUltrasound Education Group, Department of Surgery, University of Melbourne; Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Curr Opin Anaesthesiol. 2016 Dec;29(6):683-690. doi: 10.1097/ACO.0000000000000399.
Recovery after surgery is a complex interplay of the patient, the surgery, and the perioperative anaesthesia management. Assessment of recovery should address the needs of multiple stakeholders, including the institutions and healthcare providers, but primarily should be focused on the patients and their perception of quality of recovery and return to normalcy. This review will summarize the development of assessment of recovery to a multidimensional dichotomous construct that requires a real-time assessment tool validated for repeat measures and containing cognitive assessment.
Recovery is neither defined by a single composite number nor is it quantified at a single time point, but rather it is a continuum occurring in multiple domains and over periods of time from hours, to days to weeks or months after surgery. Recovery is often incomplete which may persist long term, leading to patient suffering, loss of work, and increased demands on family and healthcare providers long after apparently successful surgery. The important correlation between poor recovery, cognitive decline, institutional placement, and increased short and long-term mortality has been hampered by the heterogeneity of definitions and tools used and their assessment of recovery as a continuous vs. dichotomous score and at the group vs. individual level. Most research has been aimed at audit or group comparison rather than attempting to identify incomplete recovery at an early time period after surgery in specific patients and individualization of care based on the domain where recovery has failed.
Recovery is best defined as a multidimensional dichotomous construct encompassing nociceptive, emotive, functional, and cognitive domains. Its assessment tool should provide both real-time and restrospective recovery data, thus enabling clinical and research applications, and be validated for repeat measures over a breadth of multiple clinically relevant postoperative time points.
手术后的恢复是患者、手术及围手术期麻醉管理之间复杂的相互作用。恢复情况的评估应满足包括机构和医疗服务提供者在内的多个利益相关者的需求，但主要应关注患者及其对恢复质量和恢复正常状态的认知。本综述将总结恢复评估发展为多维二分法结构的过程，这需要一种经过验证可用于重复测量且包含认知评估的实时评估工具。
恢复情况既不是由单一综合数值定义，也不是在单个时间点进行量化，而是一个在多个领域中持续存在的过程，从手术后数小时到数天、数周或数月不等。恢复往往并不完全，可能会长期持续，导致患者痛苦、工作损失，并且在看似成功的手术后很长时间内对家庭和医疗服务提供者的需求增加。恢复不佳、认知能力下降、机构安置以及短期和长期死亡率增加之间的重要关联，因所用定义和工具的异质性以及它们将恢复评估为连续评分还是二分法评分、在群体层面还是个体层面而受到阻碍。大多数研究旨在进行审计或群体比较，而不是试图在手术后早期识别特定患者的恢复不完全情况，并根据恢复失败的领域进行个体化护理。
恢复最好被定义为一个包含伤害感受、情感、功能和认知领域的多维二分法结构。其评估工具应提供实时和回顾性的恢复数据，从而实现临床和研究应用，并在多个临床相关的术后时间点上经过验证可用于重复测量。
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