Self-Reported, Structured Measures of Recovery to Detect Postoperative Morbidity

Aida Anetsberger, Manfred Blobner, Veronika Krautheim, Katrin Umgelter, Sebastian Schmid, Bettina Jungwirth, Aida Anetsberger, Manfred Blobner, Veronika Krautheim, Katrin Umgelter, Sebastian Schmid, Bettina Jungwirth

Abstract

Previous studies have focused on postoperative anaesthetic visit as a tool for measuring postoperative recovery or patient's satisfaction. Whether it could also improve timely recognition of complications has not been studied yet. Aim of our study was to assess pathological findings in physical examination requiring further intervention during postoperative visit and to explore whether a self-administered version of the Quality of Recovery (QoR)-9 score, compared to a detailed medical history, can act as a screening tool for identification of patients who show a low risk to develop postoperative complications. This observational study included 918 patients recovering from various types of non-cardiac surgery and anaesthesia. The postoperative visit implied three steps: measuring the QoR-9 score, a structured medical history and a physical examination. QoR-9-score showed a comparable negative predictive value (0.93 vs. 0.92) and a higher sensitivity of finding at least one pathological examination than a detailed medical history (0.92 vs. 0.81 respectively). At least one postoperative pathological examination finding was observed in 23.7% of the patients. Our approach presents a strategy on screening postoperative patients in order to identify patients whose examination and consequent treatment should be intensified. In further studies the question could be addressed whether the postoperative visit may help to reduce complications and mortality after surgery.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Consort diagram.
Fig 1. Consort diagram.
Fig 2. Risk to overlook a patient…
Fig 2. Risk to overlook a patient with a pathological examination result using QoR-9 vs. medical history depending on the prevalence.

References

    1. Haynes AB, Weiser TG, William RB, Lipsitz SR, Breizat AHS, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009; 360: 491–499 10.1056/NEJMsa0810119
    1. Weiser TG, Regenbogen ST, Thompson KD, Haynes AB, Lipsitz SR, Berry WR, et al. An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet. 2008; 372: 139–144 10.1016/S0140-6736(08)60878-8
    1. Silber JH, Williams SV, Krakauer H, Schwartz JS. Hospital and patient characteristics associated with death after surgery: a study of adverse occurrence and failure to rescue. Med Care. 1992; 30: 615–629
    1. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009; 361: 1368–1375 10.1056/NEJMsa0903048
    1. Pearse RM, Moreno RP, Bauer P, Pelosi P, Metnitz P, Spies C, et al. Mortality after surgery in Europe: a 7 day cohort study. Lancet. 2012; 380: 1059–1065 10.1016/S0140-6736(12)61148-9
    1. Myles PS, Hunt JO, Nightingale, Fletcher H, Beh T, Tanil D, et al. Development and Psychometric Testing of a Quality of Recovery Score After General Anesthesia and Surgery in Adults. Anesth Analg. 1999; 88: 83–90.
    1. Eberhart LHJ, Greiner S, Geldner G, Wulf H. Patientenbeurteilung der postoperativen Erholung. Anaesthesist. 2002; 52:463–46.
    1. Bennett-Guerrero E, Welsby I, Dunn TJ, Young LR, Wahl TA, Diers TL, et al. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery. Anesth Analg 1999; 89: 514–9
    1. S3-Guideline: Treatment of acute postoperative and posttraumatic pain. AWMF-Registry Nr. 041/001. 2007; 201: 1–394.
    1. Dexter F, Aker J, Wright WA. Development of a measure of patient satisfaction with monitored anesthesia care: the Iowa Satisfaction with Anesthesia Scale. Anesthesiology 1997; 87:865–73
    1. Barnett SF, Alagar RK, Grocott MPW, Giannaris S, Dick JR, Moonesinghe SR. Patient-satisfaction measures in Anesthesia. Anesthesiology 2013. 119: 452–78 10.1097/ALN.0b013e3182976014
    1. Herrera FJ, Wong J, Chung F. A Systematic Review of Postoperative Recovery Outcomes Measurements after ambulatory Surgery. Anesth Analg. 2007;105: 63–69
    1. Saal D, Heidegger T, Nuebling M, Germann R. Does a postoperative visit increase patient satisfaction with anaesthesia care? Br J Anaesth. 2011; 107: 703–709. 10.1093/bja/aer261
    1. Arnberger M, Vogt A, Studer P, Inderbitzin D, Pulver C, Roehrig B, et al. Evaluation of physical and mental recovery status after elective liver resection. Eur J Anaesthesiol. 2009; 26: 559–565
    1. Gornall BF, Myles PS, Smith CL, Burke JA, Leslie K, Pereira MJ, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. Br J Anaesth. 2013; 111: 161–169 10.1093/bja/aet014
    1. Myles PS, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a postoperative quality of recovery score: the QoR-40. Br J Anaesth. 2000; 84: 11–15

Source: PubMed

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