Postpartum Quality of Recovery & Maternal Satisfaction After C/S (QuReS)

Relationship Between Patient Reported Postpartum Quality of Recovery and Maternal Satisfaction After Cesarean Delivery: A Prospective Observational Study

Measuring patient-oriented outcomes and satisfaction is important to guide meaningful changes in obstetric anesthesia care. Quality of Recovery (QoR) scores are patient rated measures, which provide a global measure of recovery after surgery. They go beyond the measure of physiological variables to include, physical, cognitive, emotive and functional outcomes. Satisfaction, in addition to QoR scores after anaesthesia is an important quality marker. Measuring satisfaction after the birth of a child is a complex and emotive subject. Understanding the factors that can influence maternal satisfaction may improve patient-centred care. Studies have shown that despite favorable clinical outcomes, many women undergoing caesarean deliveries continue to have poor experience with anaesthesia. These poor experiences go beyond inadequate pain control; many are due to poor communication with clinicians, lack of involvement in decision making, lack of provision of high quality education and information and a feeling of inadequate choice and control relating to decisions of the birth of their babies. In non-obstetric studies, satisfaction after anaesthesia has consistently been shown to be dependent on the information patient has received along with the quality of the communication and the quality of the anaesthetist-patient relationship.

Study Overview

• Status: Completed
• Conditions: Postpartum Women

• Study Type: Observational
• Enrollment (Actual): 300

Contacts and Locations

Study Locations

• Canada
  • British Columbia
    • Vancouver, British Columbia, Canada, V6H 3N1
      • BC Women's Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All women above the age of 19 years old whom underwent a caesarean section will be eligible to participate. Women will be surveyed at 24 hours after their cesarean section. Data will be collected by means of validated paper questionnaires administered in person by a study investigator that is not part of clinical care.

Description

Inclusion Criteria:

• Fluent English speaker
• Older than 19 years of age
• Received a cesarean delivery
• Received a cesarean delivery 24-48 hours prior to time of recruitment

Exclusion Criteria:

• Non-English speaker
• Below the age of 19 years
• Did not receive a cesarean delivery
• Received a cesarean delivery more than 48hrs after time of recruitment

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of Recovery Score (ObsQoR-11)	Quality of recovery will be measured using the obstetric quality of recovery score (ObsQoR-11). This is a 11-item, multidimensional recovery scoring tool, which has been validated in this population	5 Minutes
Maternal Satisfaction Scale for Cesarean Section (MSSCS)	This 22 item questionnaire measures satisfaction with the anaesthetic, needle insertion, side effects and the theatre atmosphere. Items are rated on a 7-point likert scale from strongly disagree to strongly agree.	5 Minutes
Satisfaction with Received Care	First open ended question assessing: "What aspects of your care were you most satisfied with?"	1 Minute
Dissatisfaction with Received Care	Second open ended question assessing: "What aspects of your care were you most dissatisfied with?"	1 Minute
Improvement of Satisfaction	Third and last open ended question assessing: "Do you have any suggestions on what would improve your satisfaction?"	1 Minute

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Obstetric History: Gravidity and Preterm	Total frequency of gravidity and preterm	1 Minute
Patient Age	Patient age in years	1 Minute
Gestational Age	Gestational age in total weeks and days	1 Minute
Patient Height	Patient height measured in centimeters	1 Minute
Patient Weight	Patient weight measured in kilograms	1 Minute
Outcome of Delivery	Result of singleton, twins, or other	1 Minute
Neonatal APGARs	APGAR scores at 1 minute and minutes	1 Minute
Neonatal Birthweight	Neonatal birthweight measured in grams	1 Minute
Patient ASA Status	American Society of Anesthesiologists (ASA) physical status classification system ranging from 1 to 6	1 Minute
Pregnancy Medical Conditions	Including: pregnancy induced HTN, pre-eclampsia, gestational diabetes, anemia, hyperemesis, cholestasis, and other.	1 Minute
Medical Conditions Outside Pregnancy	Including any medical conditions that do not constitute a pregnancy medical condition	1 Minute
Intraoperative Anxiolytics	Intraoperative anxiolytics drug and dose administered prior and during the cesarean section procedure.	1 Minute
Anesthesia Procedure Start	Time in military time format	1 Minute
Urgency of Cesarean Delivery	Classified as: scheduled, STAT, P1, or P2	1 Minute
Indication for Cesarean Delivery	Reason for cesarean delivery	1 Minute
Labour Onset	Indicated as: spontaneous, augmented, or induction of labour	1 Minute
Labour Length	Length of hours for both first stage and second stage	1 Minute
Pain Relief During Labour	Indicated as: epidural/CSE/DPE, Entonox, M&G, or other	1 Minute
Intraoperative Complications	Indicated as: hypotension, shivering, nausea, vomiting, itch, failed neuraxial, or other.	1 Minute
Intraoperative Blood Loss	Blood loss measured in milliliters.	1 Minute
Postoperative Complications	Any medical complication indicated after the caesarean delivery.	1 Minute
Neuraxial Lidocaine	Neuraxial agents and dosage administered prior and during the cesarean section procedure.	1 Minute
Neuraxial Bupivicaine	dosage administered prior and during the cesarean section procedure.	1 Minute
Neuraxial Morphine	dosage administered prior and during the cesarean section procedure.	1 Minute
Neuraxial Fentanyl	dosage administered prior and during the cesarean section procedure.	1 Minute

Collaborators and Investigators

• Sponsor: University of British Columbia
• Investigators: Principal Investigator: Anton Chau, MD MMSc, University of British Columbia

Publications and helpful links

General Publications

• Ciechanowicz S, Setty T, Robson E, Sathasivam C, Chazapis M, Dick J, Carvalho B, Sultan P. Development and evaluation of an obstetric quality-of-recovery score (ObsQoR-11) after elective Caesarean delivery. Br J Anaesth. 2019 Jan;122(1):69-78. doi: 10.1016/j.bja.2018.06.011. Epub 2018 Jul 31.
• Bowyer A, Jakobsson J, Ljungqvist O, Royse C. A review of the scope and measurement of postoperative quality of recovery. Anaesthesia. 2014 Nov;69(11):1266-78. doi: 10.1111/anae.12730. Epub 2014 Jun 2.
• Heidegger T, Saal D, Nubling M. Patient satisfaction with anaesthesia - Part 1: satisfaction as part of outcome - and what satisfies patients. Anaesthesia. 2013 Nov;68(11):1165-72. doi: 10.1111/anae.12347. Epub 2013 Aug 8.
• Barnett SF, Alagar RK, Grocott MP, Giannaris S, Dick JR, Moonesinghe SR. Patient-satisfaction measures in anesthesia: qualitative systematic review. Anesthesiology. 2013 Aug;119(2):452-78. doi: 10.1097/ALN.0b013e3182976014.
• Camann W. Pain, Pain Relief, Satisfaction and Excellence in Obstetric Anesthesia: A Surprisingly Complex Relationship. Anesth Analg. 2017 Feb;124(2):383-385. doi: 10.1213/ANE.0000000000001676. No abstract available.
• Kingsley C, Patel S. Patient-reported outcome measures and patient-reported experience measures. BJA Education. 2017;17(4):137-44.
• Linda D. Results of the National Maternity Experience Survey 2020 2020 [Available from: https://yourexperience.ie/maternity/national-results/.
• Porter M, van Teijlingen E, Chi Ying Yip L, Bhattacharya S. Satisfaction with cesarean section: qualitative analysis of open-ended questions in a large postal survey. Birth. 2007 Jun;34(2):148-54. doi: 10.1111/j.1523-536X.2007.00161.x.
• Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995 May 1;152(9):1423-33.
• Cook K, Loomis C. The Impact of Choice and Control on Women's Childbirth Experiences. J Perinat Educ. 2012 Summer;21(3):158-68. doi: 10.1891/1058-1243.21.3.158.
• Brooks H, Sullivan WJ. The importance of patient autonomy at birth. Int J Obstet Anesth. 2002 Jul;11(3):196-203. doi: 10.1054/ijoa.2002.0958.
• Morgan PJ, Halpern S, Lo J. The development of a maternal satisfaction scale for caesarean section. Int J Obstet Anesth. 1999 Jul;8(3):165-70. doi: 10.1016/s0959-289x(99)80132-0.
• Berning V, Laupheimer M, Nubling M, Heidegger T. Influence of quality of recovery on patient satisfaction with anaesthesia and surgery: a prospective observational cohort study. Anaesthesia. 2017 Sep;72(9):1088-1096. doi: 10.1111/anae.13906. Epub 2017 May 16.
• Myles PS, Reeves MD, Anderson H, Weeks AM. Measurement of quality of recovery in 5672 patients after anaesthesia and surgery. Anaesth Intensive Care. 2000 Jun;28(3):276-80. doi: 10.1177/0310057X0002800304.
• Ciechanowicz S, Howle R, Heppolette C, Nakhjavani B, Carvalho B, Sultan P. Evaluation of the Obstetric Quality-of-Recovery score (ObsQoR-11) following non-elective caesarean delivery. Int J Obstet Anesth. 2019 Aug;39:51-59. doi: 10.1016/j.ijoa.2019.01.010. Epub 2019 Feb 2.

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2021
• Primary Completion (Actual): January 15, 2022
• Study Completion (Actual): June 17, 2024

Study Registration Dates

• First Submitted: September 30, 2021
• First Submitted That Met QC Criteria: September 30, 2021
• First Posted (Actual): October 14, 2021

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: February 15, 2025
• Last Verified: February 1, 2025

More Information

Terms related to this study

• Other Study ID Numbers: H21-01082

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No