Quality of recovery following childbirth: a prospective, multicentre cohort study

Abstract

Summary To better understand outcomes in postpartum patients who receive peripartum anaesthetic interventions, we aimed to assess quality of recovery metrics following childbirth in a UK‐based multicentre cohort study. This study was performed during a 2‐week period in October 2021 to assess in‐ and outpatient post‐delivery recovery at 1 and 30 days postpartum. The following outcomes were reported: obstetric quality of recovery 10‐item measure (ObsQoR‐10); EuroQoL (EQ‐5D‐5L) survey; global health visual analogue scale; postpartum pain scores at rest and movement; length of hospital stay; readmission rates; and self‐reported complications. In total, 1638 patients were recruited and responses analysed from 1631 (99.6%) and 1282 patients (80%) at one and 30 days postpartum, respectively. Median (IQR [range]) length of stay postpartum was 39.3 (28.5–61.0 [17.7–513.4]), 40.3 (28.5–59.1 [17.8–220.9]), and 35.9 (27.1–54.1 [17.9–188.4]) h following caesarean, instrumental and vaginal deliveries, respectively. Median (IQR [range]) ObsQoR‐10 score was 75 ([62–86] 4–100) on day 1, with the lowest ObsQoR‐10 scores (worst recovery) reported by patients undergoing caesarean delivery. Of the 1282 patients, complications within the first 30 days postpartum were reported by 252 (19.7%) of all patients. Readmission to hospital within 30 days of discharge occurred in 69 patients (5.4%), with 49 (3%) for maternal reasons. These data can be used to inform patients regarding expected recovery trajectories; facilitate optimal discharge planning; and identify populations that may benefit most from targeted interventions to improve postpartum recovery experience.

Extreme inequity in analgesia and peri‐operative management of pregnant patients

“…Evidence from other countries and from other centres in the UK suggests a much higher epidural rate than the 25% reported by Halliday et al [6]. Modifications of this model can also be used to explain some negative outcomes associated with ethnicity in the study by O'Carroll et al [7], and more generally in other work reporting disparities in outcomes in racial and ethnically marginalised groups [22].…”

“…The studies by Halliday et al and O'Carroll et al highlight the specific inequities in labour analgesia [6] and caesarean section anaesthesia and surgery [7] related to deprivation and ethnicity, and the generally worrying inequities suffered by pregnant people. Even in a high-income country with free access to healthcare, the overall epidural rate was only 22%, and only 28% of the most affluent group of people were using epidurals for medical indications [6].…”

“…Within the contexts of the sustainable development goals, the Declaration of Montreal and our essential goal as anaesthetists of achieving equity in obstetric analgesia and anaesthesia, important work has been published recently in Anaesthesia. These publications highlight significant disparities in the provision of obstetric labour analgesia [6] and outcomes related to obstetric anaesthesia [7] in Scotland and England, respectively.…”

Why anaesthetists should care about postnatal care

“…It is within this context that O'Carroll et al attempted to address the questions of how quality of postnatal care is best measured and how obstetric anaesthetists can use quality metrics to contribute to improvements in the quality and outcomes of postnatal care [15].…”

Translation and validation of the French version of the ObsQoR-10 questionnaire for the evaluation of recovery after delivery: the ObsQoR-10-French

“… 7 , 8 , 9 , 10 Recently, the ObsQoR-10 questionnaire has been used in a nationwide study across 107 sites in the United Kingdom, aimed at evaluating postpartum recovery after peripartum anaesthesia interventions. 11 French is the fifth most widely spoken language in the world, with ∼280 million regular users. 12 The objective of our study was to validate the French version of the ObsQoR-10 questionnaire (ObsQoR-10-French) to measure the quality of early postpartum recovery in French-speaking populations.…”