More than just morbidity and mortality - quality of recovery and long-term functional recovery after surgery

P S Myles, P S Myles

Abstract

Traditional surgical outcome measures include minor and major complications, hospital length of stay and sometimes longer-term survival. Each of these is important but there needs to be greater emphasis on patient-reported outcome measures. Global measures of a patient's quality of recovery, avoidance of postoperative morbidities, early hospital discharge to home (without re-admission) and longer term disability-free survival can better define postoperative recovery. A patient's recovery pathway can be mapped through the immediate days or weeks after surgery with documentation of morbidity using the postoperative morbidity survey and/or a quality of recovery score, days alive and at home up to 30 days after surgery and then longer term disability-free survival using the WHO Disability Assessment Schedule 2.0 scale. These can be used to define quality of recovery after surgery.

Keywords: anaesthesia; disability-free survival; patient-centred outcomes; peri-operative medicine; surgery.

© 2020 Association of Anaesthetists.

References

    1. Shulman M, Myles P. Measuring perioperative outcome. Current Opinion in Anesthesiology 2016; 29: 733-8.
    1. Myles PS. Meaningful outcome measures in cardiac surgery. Journal of Extra-Corporeal Technology 2014; 46: 23-7.
    1. Myles P, Hunt J, Nightingale C, et al. Development and psychometric testing of a quality of recovery score after general anesthesia and surgery in adults. Anesthesia and Analgesia 1999; 88: 83-90.
    1. Lee A, Lum M. Measuring anaesthetic outcomes. Anaesthesia and Intensive Care 1996; 24: 685-93.
    1. Boney O, Nathanson MH, Grocott MPW, Metcalf L. Differences between patients’ and clinicians’ research priorities from the Anaesthesia and Peri-operative Care Priority Setting Partnership. Anaesthesia 2017; 72: 1134-8.
    1. Kluivers KB, Riphagen I, Vierhout ME, Brolmann HA, de Vet HC. Systematic review on recovery specific quality-of-life instruments. Surgery 2008; 143: 206-15.
    1. Herrera FJ, Wong J, Chung F. A systematic review of postoperative recovery outcomes measurements after ambulatory surgery. Anesthesia and Analgesia 2007; 105: 63-9.
    1. Shulman MA, Myles PS, Chan MT, McIlroy DR, Wallace S, Ponsford J. Measurement of disability-free survival after surgery. Anesthesiology 2015; 122: 524-36.
    1. Dimick JB, Upchurch GR Jr. Measuring and improving the quality of care for abdominal aortic aneurysm surgery. Circulation 2008; 117: 2534-41.
    1. Birkmeyer JD, Dimick JB, Birkmeyer NJ. Measuring the quality of surgical care: structure, process, or outcomes? Journal of the American College of Surgeons 2004; 198: 626-32.
    1. Donabedian A. Evaluating the quality of medical care. Milbank Memorial Fund Quarterly 1966; 44(Suppl): 166-206.
    1. Ohrn A, Olai A, Rutberg H, Nilsen P, Tropp H. Adverse events in spine surgery in Sweden: a comparison of patient claims data and national quality register (Swespine) data. Acta Orthopaedica 2011; 82: 727-31.
    1. Bruce J, Russell EM, Mollison J, Krukowski ZH. The measurement and monitoring of surgical adverse events. Health Technology Assessment 2001; 5: 1-194.
    1. Boney O, Moonesinghe SR, Myles PS, Grocott MP. Standardizing endpoints in perioperative research. Canadian Journal of Anesthesia 2016; 63: 159-68.
    1. Myles PS, Grocott MP, Boney O, Moonesinghe SR. Standardizing end points in perioperative trials: towards a core and extended outcome set. British Journal of Anaesthesia 2016; 116: 586-9.
    1. Myles PS, Boney O, Botti M, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: patient comfort. British Journal of Anaesthesia 2018; 120: 705-11.
    1. Abbott TEF, Fowler AJ, Pelosi P, et al. A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications. British Journal of Anaesthesia 2018; 120: 1066-79.
    1. Buggy DJ, Freeman J, Johnson MZ, et al. Systematic review and consensus definitions for standardised endpoints in perioperative medicine: postoperative cancer outcomes. British Journal of Anaesthesia 2018; 121: 38-44.
    1. Barnes J, Hunter J, Harris S, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: infection and sepsis. British Journal of Anaesthesia 2019; 122: 500-8.
    1. McIlroy DR, Bellomo R, Billings FT, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine (StEP) initiative: renal endpoints. British Journal of Anaesthesia 2018; 121: 1013-24.
    1. Ross A, Young J, Hedin R, et al. A systematic review of outcomes in postoperative pain studies in paediatric and adolescent patients: towards development of a core outcome set. Anaesthesia 2018; 73: 375-83.
    1. Alkhaffaf B, Glenny AM, Blazeby JM, Williamson P, Bruce IA. Standardising the reporting of outcomes in gastric cancer surgery trials: protocol for the development of a core outcome set and accompanying outcome measurement instrument set (the GASTROS study). Trials 2017; 18: 370.
    1. Ruparelia N, Latib A. The drive towards standardised clinical study endpoints in transcatheter aortic valve interventions. EuroIntervention 2016; 12: 298-300.
    1. Vather R, Trivedi S, Bissett I. Defining postoperative ileus: results of a systematic review and global survey. Journal of Gastrointestinal Surgery 2013; 17: 962-72.
    1. Breyer JZ, Giacomazzi J, Kuhmmer R, et al. Hospital quality indicators: a systematic review. International Journal of Health Care Quality Assurance 2019; 32: 474-87.
    1. Haller G, Stoelwinder J, Myles PS, McNeil J. Quality and safety indicators in anesthesia: a systematic review. Anesthesiology 2009; 110: 1158-75.
    1. Haller G, Myles PS, Wolfe R, Weeks AM, Stoelwinder J, McNeil J. Validity of unplanned admission to an intensive care unit as a measure of patient safety in surgical patients. Anesthesiology 2005; 103: 1121-9.
    1. Ingraham AM, Richards KE, Hall BL, Ko CY. Quality improvement in surgery: the American College of Surgeons National Surgical Quality Improvement Program approach. Advances in Surgery 2010; 44: 251-67.
    1. Eugene N, Oliver CM, Bassett MG, et al. Development and internal validation of a novel risk adjustment model for adult patients undergoing emergency laparotomy surgery: the National Emergency Laparotomy Audit risk model. British Journal of Anaesthesia 2018; 121: 739-48.
    1. Jacobs JP, Shahian DM, D'Agostino RS, et al. The Society of Thoracic Surgeons National Database 2018 Annual Report. Annals of Thoracic Surgery 2018; 106: 1603-11.
    1. Rebasa P, Mora L, Luna A, Montmany S, Vallverdu H, Navarro S. Continuous monitoring of adverse events: influence on the quality of care and the incidence of errors in general surgery. World Journal of Surgery 2009; 33: 191-8.
    1. Haller G, Myles PS, Stoelwinder J, Langley M, Anderson H, McNeil J. Integrating incident reporting into an electronic patient record system. Journal of the American Medical Informatics Association 2007; 14: 175-81.
    1. Brooke BS, Perler BA, Dominici F, Makary MA, Pronovost PJ. Reduction of in-hospital mortality among California hospitals meeting Leapfrog evidence-based standards for abdominal aortic aneurysm repair. Journal of Vascular Surgery 2008; 47: 1155-6; discussion 63-4.
    1. Roques F, Nashef SA, Michel P, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. European Journal of Cardio-Thoracic Surgery 1999; 15: 816-22-22; discussion 22-3.
    1. Goodnough LT, Johnston MF, Toy PT. The variability of transfusion practice in coronary artery bypass surgery. Transfusion Medicine Academic Award Group. Journal of the American Medical Association 1991; 265: 86-90.
    1. Blencowe NS, Strong S, McNair AG, et al. Reporting of short-term clinical outcomes after esophagectomy: a systematic review. Annals of Surgery 2012; 255: 658-66.
    1. Myles PS. Measuring quality of recovery in perioperative clinical trials. Current Opinion in Anesthesiology 2018; 31: 396-401.
    1. Porter ME, Lee TH. From volume to value in health care: the work begins. Journal of the American Medical Association 2016; 316: 1047-8.
    1. Hollen PJ, Msaouel P, Gralla RJ. Determining issues of importance for the evaluation of quality of life and patient-reported outcomes in breast cancer: results of a survey of 1072 patients. Breast Cancer Research and Treatment 2015; 151: 679-86.
    1. Haywood K, Brett J, Salek S, et al. Patient and public engagement in health-related quality of life and patient-reported outcomes research: what is important and why should we care? Findings from the first ISOQOL patient engagement symposium. Quality of Life Research 2015; 24: 1069-76.
    1. Koch CG, Li L, Lauer M, Sabik J, Starr NJ, Blackstone EH. Effect of functional health-related quality of life on long-term survival after cardiac surgery. Circulation 2007; 115: 692-9.
    1. Lovelock TM, Broughton NS, Williams CM. The popularity of outcome measures for hip and knee arthroplasties. Journal of Arthroplasty 2018; 33: 273-6.
    1. Baron SJ, Arnold SV, Wang K, et al. Health status benefits of transcatheter vs surgical aortic valve replacement in patients with severe aortic stenosis at intermediate surgical risk: results from the PARTNER 2 randomized clinical trial. Journal of the American Medical Association Cardiology 2017; 2: 837-45.
    1. Gornall BF, Myles PS, Smith CL, et al. Measurement of quality of recovery using the QoR-40: a quantitative systematic review. British Journal of Anaesthesia 2013; 111: 161-9.
    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. Bauer M, Bohrer H, Aichele G, Bach A, Martin E. Measuring patient satisfaction with anaesthesia: perioperative questionnaire versus standardised face-to-face interview. Acta Anaesthesiologica Scandinavica 2001; 45: 65-72.
    1. Royse CF, Newman S, Chung F, et al. Development and feasibility of a scale to assess postoperative recovery: the post-operative quality recovery scale. Anesthesiology 2010; 113: 892-905.
    1. Fujimori T, Okuda S, Iwasaki M, et al. Validity of the Japanese Orthopaedic Association scoring system based on patient-reported improvement after posterior lumbar interbody fusion. Spine Journal 2016; 16: 728-36.
    1. Myles P, Hunt J, Fletcher H, Smart J, Jackson T. Part 1: propofol, thiopental, sevoflurane and isoflurane - a randomized controlled trial of effectiveness. Anesthesia and Analgesia 2000; 91: 1163-9.
    1. Myles P, Weitkamp B, Jones K, Melick J, Hensen S. Validity and reliability of a post-operative quality of recovery score: the QoR-40. British Journal of Anaesthesia 2000; 84: 11-5.
    1. Stark PA, Myles PS, Burke JA. Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology 2013; 118: 1332-40.
    1. Bu XS, Zhang J, Zuo YX. Validation of the Chinese version of the quality of recovery-15 score and its comparison with the post-operative quality recovery scale. Patient 2016; 9: 251-9.
    1. Eberhart LH, Greiner S, Geldner G, Wulf H. Patient evaluation of postoperative recovery. An evaluation of the QoR scores in 577 patients. Anaesthesist 2002; 51: 463-6.
    1. Chan MT, Lo CC, Lok CK, Chan TW, Choi KC, Gin T. Psychometric testing of the Chinese quality of recovery score. Anesthesia and Analgesia 2008; 107: 1189-95.
    1. Kleif J, Edwards HM, Sort R, Vilandt J, Gogenur I. Translation and validation of the Danish version of the postoperative quality of recovery score QoR-15. Acta Anaesthesiologica Scandinavica 2015; 59: 912-20.
    1. Lyckner S, Boregard IL, Zetterlund EL, Chew MS. Validation of the Swedish version of Quality of Recovery score - 15: a multicentre, cohort study. Acta Anaesthesiologica Scandinavica 2018; 62: 893-902.
    1. Chazapis M, Walker EM, Rooms MA, Kamming D, Moonesinghe SR. Measuring quality of recovery-15 after day case surgery. British Journal of Anaesthesia 2016; 116: 241-8.
    1. Yaghoobi S, Hamidfar M, Lawson DM, Fridlund B, Myles PS, Pakpour AH. Validity and reliability of the Iranian version of the Quality of Recovery-40 Questionnaire. Anesthesiology and Pain Medicine 2015; 5: e20350.
    1. Tanaka Y, Wakita T, Fukuhara S, et al. Validation of the Japanese version of the quality of recovery score QoR-40. Journal of Anesthesia 2011; 25: 509-15.
    1. Terkawi AS, Myles PS, Riad W, et al. Development and validation of Arabic version of the postoperative quality of recovery-40 questionnaire. Saudi Journal of Anaesthesia 2017; 11: S40-52.
    1. Idvall E, Berg K, Unosson M, Brudin L, Nilsson U. Assessment of recovery after day surgery using a modified version of quality of recovery-40. Acta Anaesthesiologica Scandinavica 2009; 53: 673-7.
    1. Nilsson U, Dahlberg K, Jaensson M. The Swedish web version of the quality of recovery scale adapted for use in a mobile app: prospective psychometric evaluation study. JMIR MHealth UHealth 2017; 5: e188.
    1. Pitimana-Aree S, Udompanthurak S, Lapmahapaisan S, Tareerath M, Wangdee A. Validity and reliability of quality of recovery-35 Thai version: a prospective questionnaire-based study. BMC Anesthesiology 2016; 16: 64.
    1. Karaman S, Arici S, Dogru S, et al. Validation of the Turkish version of the Quality of Recovery-40 Questionnaire. Health and Quality of Life Outcomes 2014; 12: 8.
    1. Myles PS, Myles DB, Galagher W, Chew C, MacDonald N, Dennis A. Minimal clinically important difference for three quality of recovery scales. Anesthesiology 2016; 125: 39-45.
    1. Myles PS, Hunt JO, Fletcher H, Solly R, Woodward D, Kelly S. Relation between quality of recovery in hospital and quality of life at 3 months after cardiac surgery. Anesthesiology 2001; 95: 862-7.
    1. Bennett-Guerrero E, Welsby I, Dunn TJ, et al. The use of a postoperative morbidity survey to evaluate patients with prolonged hospitalization after routine, moderate-risk, elective surgery. Anesthesia and Analgesia 1999; 89: 514-19.
    1. Grocott MP, Browne JP, Van der Meulen J, et al. The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery. Journal of Clinical Epidemiology 2007; 60: 919-28.
    1. Wong DJN, Oliver CM, Moonesinghe SR. Predicting postoperative morbidity in adult elective surgical patients using the Surgical Outcome Risk Tool (SORT). British Journal of Anaesthesia 2017; 119: 95-105.
    1. Marufu TC, Elphick HL, Ahmed FB, Moppett IK. Short-term morbidity factors associated with length of hospital stay (LOS): development and validation of a Hip Fracture specific postoperative morbidity survey (HF-POMS). Injury 2019; 50: 931-38.
    1. Sanders J, Keogh BE, Van der Meulen J, et al. The development of a postoperative morbidity score to assess total morbidity burden after cardiac surgery. Journal of Clinical Epidemiology 2012; 65: 423-33.
    1. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of Surgery 2004; 240: 205-13.
    1. Graham LA, Mull HJ, Wagner TH, et al. Comparison of a potential hospital quality metric with existing metrics for surgical quality-associated readmission. Journal of the American Medical Association Network Open 2019; 2: e191313.
    1. Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. New England Journal of Medicine 2014; 370: 1494-503.
    1. Glance LG, Kellermann AL, Osler TM, et al. Hospital readmission after noncardiac surgery: the role of major complications. Journal of the American Medical Association Surgery 2014; 149: 439-45.
    1. Birkmeyer JD, Gust C, Dimick JB, Birkmeyer NJ, Skinner JS. Hospital quality and the cost of inpatient surgery in the United States. Annals of Surgery 2012; 255: 1-5.
    1. Hyder JA, Hirschberg RE, Nguyen LL. Home discharge as a performance metric for surgery. Journal of the American Medical Association Surgery 2015; 150: 96-7.
    1. Berian JR, Mohanty S, Ko CY, Rosenthal RA, Robinson TN. Association of loss of independence with readmission and death after discharge in older patients after surgical procedures. Journal of the American Medical Association Surgery 2016; 151: e161689.
    1. Hinami K, Bilimoria KY, Kallas PG, Simons YM, Christensen NP, Williams MV. Patient experiences after hospitalizations for elective surgery. American Journal of Surgery 2014; 207: 855-62.
    1. Bell M, Eriksson LI, Svensson T, et al. Days at home after surgery: an integrated outcome measure for clinical trials and quality assurance. EClinical Medicine 2019; 11: 18-26.
    1. Myles PS, Shulman MA, Heritier S, et al. Validation of days at home as an outcome measure after surgery: a prospective cohort study in Australia. British Medical Journal Open 2017; 7: e015828.
    1. Jerath A, Austin PC, Wijeysundera DN. Days alive and out of hospital: validation of a patient-centered outcome for perioperative medicine. Anesthesiology 2019; 131: 84-93.
    1. Khuri SF, Henderson WG, DePalma RG, Mosca C, Healey NA, Kumbhani DJ. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Annals of Surgery 2005; 242: 326-41.
    1. Myles PS. Untangling the triple low: causal inference in anesthesia research. Anesthesiology 2014; 121: 1-3.
    1. Leslie K, Short TG. Sedation depth and mortality: a large randomized trial is required. Anesthesia and Analgesia 2014; 118: 903-5.
    1. Monk T, Saini V, Weldon B, Sigl J. Anesthetic management and one-year mortality after noncardiac surgery. Anesthesia and Analgesia 2005; 100: 4-10.
    1. Sessler DI, Sigl JC, Kelley SD, et al. Hospital stay and mortality are increased in patients having a ‘triple low” of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia. Anesthesiology 2012; 116: 1195-203.
    1. Groff AC, Colla CH, Lee TH. Days spent at home - a patient-centered goal and outcome. New England Journal of Medicine 2016; 375: 1610-12.
    1. Krumholz HM. Post-hospital syndrome-an acquired, transient condition of generalized risk. New England Journal of Medicine 2013; 368: 100-2.
    1. World Health Organization. Classification of Functioning, Disability and Health. World Health Organization 2001; Geneva: 1-299.
    1. Andrews G, Kemp A, Sunderland M, Von Korff M, Ustun TB. Normative data for the 12 item WHO Disability Assessment Schedule 2.0. PLoS One 2009; 4: e8343.
    1. Myles P, Bellomo R, Corcoran T, et al. Restrictive versus liberal fluid therapy in major abdominal surgery (RELIEF): rationale and design for a multicentre randomised trial. British Medical Journal Open 2017; 7: e015358.
    1. Joosten A, Delaporte A, Mortier J, et al. Long-term impact of crystalloid versus colloid solutions on renal function and disability-free survival after major abdominal surgery. Anesthesiology 2019; 130: 227-36.

Source: PubMed

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