Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
PLoS One. 2023 Aug 15;18(8):e0289685. doi: 10.1371/journal.pone.0289685. eCollection 2023.
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).
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.
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.
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.
患者对术后恢复的感知是围手术期护理的一个关键方面。自报告的恢复质量（QoR）已成为围手术期研究中的一个相关终点。已经引入了几种心理计量学工具来评估术后 24 小时的自报告恢复情况。然而，目前还没有适用于麻醉后护理单元（PACU）的问卷。我们旨在开发并对 PACU 的 QoR 问卷（QoR-PACU）进行心理计量学评估。
QoR-PACU 是基于 40 项 QoR-40 问卷以德文开发的。在 2020 年 3 月至 11 月期间，计划接受择期泌尿科手术的成年患者在术前和 PACU 住院期间完成了 QoR-PACU。我们评估了可行性、有效性、可靠性和反应性。
我们纳入了 375 名患者。在分别包括 72 名和 48 名患者的两个试点阶段之后，我们向 255 名患者发放了 QoR-PACU 的最终版本，完成率为 96.5%。患者在 PACU 到达后中位数 125.0（83.0；156.8）分钟完成 QoR-PACU。术后 QoR-PACU 总分与年龄（r = 0.23，95%CI：0.11 至 0.35，p < 0.001）、PACU 停留时间（r = -0.15，95%CI：-0.27 至 -0.03，p = 0.02）、PACU 疼痛（r = -0.48，95%CI：-0.57 至 -0.37，p < 0.001）和哌替啶剂量（r = -0.29，95%CI：-0.40 至 -0.17，p < 0.001）相关，具有良好的结构效度。克朗巴赫的 alpha 系数为 0.67（95%CI：0.61-0.73），具有中等的测试重测可靠性（ICC 为 0.67，95%CI：0.38 至 0.83）。科恩效应大小为 3.08，标准化反应均值为 1.65，表明具有足够的反应性。
在术后早期评估 QoR 是可行的。我们发现接受度高、有效性高、反应性足够、可靠性中等。未来的研究应在包括女性和不同围手术期风险程度的性别多样化患者在内的更多异质患者群体中评估 QoR-PACU 的心理计量学特性。
