Development and Validation of the Post-Operative Recovery Index for Measuring Quality of Recovery after Surgery

Abstract

Purpose: Current methods used to quantify aspects of recovery after surgery and anesthesia tend to be narrowly focused, not patient-rated, or have not been appropriately validated. We set out to develop a quality of recovery score system that is self-report and multi-dimensional, with applicability across various surgeries and surgical settings, from immediately post-surgery through discharge and covering the first 30 days of recovery. Methods: A Post-operative Recovery Index (PoRI) was validated on 225 patients (N Validation =96; N Cross Validation =129) who had undergone a surgical procedure within the last 30 days. Domain level internal consistency on the validation and cross validation samples yielded coefficients ranging from α=0.813 to α=0.932, while test-retest reliability yielded stability coefficients ranging from r=0.660 to r=0.881. Confirmatory factor analyses demonstrated validity of the factorial structure of the 37-item PoRI on the validation patient sample and confirmed on the cross validation patient sample. Exploratory psychometric analyses provided evidence of an overarching (second-order) "Recovery" factor. Results: We developed, tested, validated, and cross validated the Post-operative Recovery Index (PoRI) consisting of 37 items assessing symptomatology a patient may experience after surgery. Conclusion: The PoRI is offered as a valid, multidimensional measure of recovery after surgery and anesthesia with broad applicability in post-surgical settings. J o u rn al of A n e s th es ia & C li n ic a l Resea rc h

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

“…There are many other instruments that can be used to measure patient reported outcomes after surgery. These include the Postoperative Recovery Index (PORI) 44 and the Gastrointestinal Quality of Life Index (GIQLI) 45 as examples. The PORI is a quality of recovery scoring system that is self-reported and multi-dimensional.…”

Design and conduct of confirmatory chronic pain clinical trials

“… 263 A second example is opioid-related side effects, which represent another symptom cluster that includes nausea, dizziness, sedation, and constipation, and can also be assessed with several validated questionnaires. 29 , 30 Importantly, harms assessed with prospective outcome assessments will result in a higher incidence than passive AE capture, and therefore, values derived from prospective and passive measures cannot be directly compared.…”

Validity and reliability study of the Turkish version of the Postoperative Recovery Index of patients undergoing surgical intervention

“…This form was prepared based on the literature [3,9,10]. It consisted of 22 questions including medical information such as age, sex, BMI, information about the surgery they underwent, and chronic diseases.…”

“…Karaman et al [9] carried out the Turkish validity and reliability study of a measurement instrument that measures patients' postoperative emotional states, physical comfort, patient support, physical independence, and pain-related recovery quality in 2014. On the other hand, psychological symptoms, physical activities, general symptoms, bowel symptoms, and appetite symptoms can be assessed up to 30 days after discharge by using the Postoperative Recovery Index (PoRI), the validity and reliability of which was tested by Butler et al in 2012 [10]. This index is seen as a measurement tool that can be adapted to surgery types that are different from each other and can reflect versatile self-reports of the patient.…”