Approaches to the measurement of post-operative recovery

Bowyer, Andrea; Royse, Colin

doi:10.1016/j.bpa.2018.02.001

Cited by 6 publications

(6 citation statements)

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“…The key component of postoperative recovery is the patient's subjective perception of the quality of health after surgery [20]. Speci cally, Andrea Bowyer et al [21] de ned "postoperative recovery" as the process of returning to a relatively normal state of various health parameters such as physiological function, cognitive function, and independence. The purpose of this study was to compare the effects of esketamine and remifentanil on the quality of recovery after MRM.…”

Section: Discussionmentioning

confidence: 99%

Effect of perioperative continuous infusion of S-ketamine on the quality of postoperative recovery of patients undergoing modified radical mastectomy: a randomized controlled trial

Zhang

Yuan

Wang

et al. 2022

Preprint

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Background: Patients undergoing modified radical mastectomy (MRM) often suffer some postoperative adverse events such as acute pain, mental abnormalities, and sleep disorders. This study aim to explore the effect of esketamine as the sole intraoperative analgesic on the quality of postoperative recovery in patients undergoing MRM.Methods: Ninety-eight female patients scheduled for elective MRM were randomly divided into two groups: the esketamine group (group E) or remifentanil group (group R). In group E, anesthesia was induced with etomidate, midazolam, esketamine, and rocuronium, and maintained with intravenous propofol and esketamine. In group R, anesthesia was induced with etomidate, midazolam, rocuronium, and remifentanil, and maintained with propofol and remifentanil. The scores of the Quality of Recovery (QoR-40) questionnaire, and Pittsburgh Sleep Quality Index (PSQI) were evaluated at 1 d, 3 d, 7 d, and 30 d after surgery as primary outcome and main secondary outcome respectively. Other secondary outcomes including intraoperative hemodynamics, postoperative inflammatory indicator, and the incidence of adverse events (e.g., vomiting and dizziness) during hospitalization were also recorded.Main Results: QoR-40 total scores in group E were higher than group R at 1 d [160.71±9.811 VS 146.94±7.375, P＜0.001], 3 d [168.45±9.670 VS 152.90±8.089, P＜0.001], 7 d [180.06±7.367 VS 175.20±6.334, P=0.001] postoperatively. The PSQI scores in group E were lower than group R at 1 d [14.18±1.740 VS 17.20±1.87, P＜0.001], 3 d [11.82±1.799 VS 16.31±2.133, P＜0.001], 7 d [7.71±1.814 VS 9.65±1.832, P＜0.001] after surgery. Conclusion: Our research shows that esketamine has a certain effect on improving the quality of short-term recovery after MRM.Clinical Trials Registration: Clinical Trials gov: ChiCTR2200056576. registered February 8th, 2022, http://www.chictr.org.cn/index.aspx.

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Section: Discussionmentioning

confidence: 99%

Effect of perioperative continuous infusion of S-ketamine on the quality of postoperative recovery of patients undergoing modified radical mastectomy: a randomized controlled trial

Zhang

Yuan

Wang

et al. 2022

Preprint

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“…Recovery from surgery is a complex process that depends on the patient, surgical and anesthetic factors ( 3 ). The primary goal of surgical and anesthetic interventions is to improve patient prognosis, and patients tend to be more concerned with their self-perception of the disease and recovery than objective test data such as laboratory values and imaging ( 4 ). However, studies of perioperative interventions usually focus on classical postoperative outcomes, such as morbidity, postoperative organ dysfunction, or postoperative complications, while ignoring patient-centered outcome measures ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of transcranial direct current stimulation for improving postoperative quality of recovery in elderly patients undergoing lower limb major arthroplasty: a randomized controlled substudy

Tao,

Yang,

Liu

et al. 2024

Front. Neurol.

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BackgroundPrevious studies have demonstrated improvements in motor, behavioral, and emotional areas following transcranial direct current stimulation (tDCS), but no published studies have reported the efficacy of tDCS on postoperative recovery quality in patients undergoing lower limb major arthroplasty. We hypothesized that tDCS might improve postoperative recovery quality in elderly patients undergoing lower limb major arthroplasty.MethodsNinety-six patients (≥65 years) undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) were randomized to receive 2 mA tDCS for 20 min active-tDCS or sham-tDCS. The primary outcome was the 15-item quality of recovery (QoR-15) score on postoperative day one (Т2). Secondary outcomes included the QoR-15 scores at the 2nd hour (T1), the 1st month (Т3), and the 3rd month (Т4) postoperatively, numeric rating scale scores, and fatigue severity scale scores.ResultsNinety-six elderly patients (mean age, 71 years; 68.7% woman) were analyzed. Higher QoR-15 scores were found in the active-tDCS group at T2 (123.0 [114.3, 127.0] vs. 109.0 [99.3, 115.3]; median difference, 13.0; 95% CI, 8.0 to 17.0; p < 0.001). QoR-15 scores in the active-tDCS group were higher at T1 (p < 0.001), T3 (p = 0.001), and T4 (p = 0.001). The pain scores in the active-tDCS group were lower (p < 0.001 at motion; p < 0.001 at rest). The fatigue degree scores were lower in the active-tDCS group at T1 and T2 (p < 0.001 for each).ConclusiontDCS may help improve the quality of early recovery in elderly patients undergoing lower limb major arthroplasty.Clinical trial registrationThe trial was registered at the China Clinical Trial Center (ChiCTR2200057777, https://www.chictr.org.cn/showproj.html?proj=162744).

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“…There has since been development of new recovery assessment tools to account for these multidimensional, patient-centric recovery outcome measures. 18,19 The 4-6-week postoperative time point represents a critical window in the recovery trajectory and is the timepoint of interest for this review. This timepoint has been defined as the intermediate postoperative recovery phase.…”

Section: Introductionmentioning

confidence: 99%

“…However, these domains have not been adequately reflected in traditionally defined postoperative performance indicators. There has since been development of new recovery assessment tools to account for these multidimensional, patient‐centric recovery outcome measures 18,19 …”

Section: Introductionmentioning

confidence: 99%

Identifying risk factors for poor multidimensional recovery after major surgery: A systematic review

Ou-Young

Boggett

El-Ansary

et al. 2023

Acta Anaesthesiol Scand

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Traditional risk factors used for predicting poor postoperative recovery have focused on postoperative complications, adverse symptoms (nausea, pain), length of hospital stay, and patient quality of life. Despite these being traditional performance indicators of patient postoperative “status,” they may not fully define the multidimensional nature of patient recovery. The definition of postoperative recovery is thus evolving to include patient‐reported outcomes that are important to the patient. Previous reviews have focused on risk factors for the above traditional outcomes after major surgery. Yet, there remains a need for further study of risk factors predicting multidimensional patient‐focused recovery, and investigation beyond the immediate postoperative period after patients are discharged from the hospital. This review aimed to appraise the current literature identifying risk factors for multidimensional patient recovery.MethodsA systematic review without meta‐analysis was performed to qualitatively summarize preoperative risk factors for multidimensional recovery 4–6 weeks after major surgery (PROSPERO, CRD42022321626). We reviewed three electronic databases between January 2012 and April 2022. The primary outcome was risk factors for multidimensional recovery at 4–6 weeks. A GRADE quality appraisal and a risk of bias assessment were completed.ResultsIn total, 5150 studies were identified, after which 1506 duplicates were removed. After the primary and secondary screening, nine articles were included in the final review. Interrater agreements between the two assessors for the primary and secondary screening process were 86% (k = 0.47) and 94% (k = 0.70), respectively. Factors associated with poor recovery were found to include ASA grade, recovery tool baseline score, physical function, number of co‐morbidities, previous surgery, and psychological well‐being. Mixed results were reported for age, BMI, and preoperative pain. Due to the observational nature, heterogeneity, multiple definitions of recovery, and moderate risk of bias of the primary studies, the quality of evidence was rated from very low to low.ConclusionOur review found that there were few studies assessing preoperative risk factors as predictors for poor postoperative multidimensional recovery. This confirms the need for higher quality studies assessing risk for poor recovery, ideally with a consistent and multi‐dimensional definition of recovery.

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Approaches to the measurement of post-operative recovery

Cited by 6 publications

References 38 publications

Effect of perioperative continuous infusion of S-ketamine on the quality of postoperative recovery of patients undergoing modified radical mastectomy: a randomized controlled trial

Effect of perioperative continuous infusion of S-ketamine on the quality of postoperative recovery of patients undergoing modified radical mastectomy: a randomized controlled trial

Efficacy of transcranial direct current stimulation for improving postoperative quality of recovery in elderly patients undergoing lower limb major arthroplasty: a randomized controlled substudy

Identifying risk factors for poor multidimensional recovery after major surgery: A systematic review

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