Postoperative Quality of Recovery Scale

Quality of recovery following surgery & anaesthesia is of vital importance to improving patient outcome & clinical practice.

The PostopQRS is a measurement tool to assess multiple domains of post-operative recovery over time

Development of the PostopQRS

In 2007 a group of anaesthesiologists and neuropsychologists formed a research group with the purpose of determining the best way to measure quality of recovery from anaesthesia and surgery. This group was supported by Baxter Healthcare Corporation and was inspired by recognition that quality of recovery was an important but under recognised part of anaesthesia and surgical care. As an indication of the commitment they wish to make to this speciality, for the benefit of both the anaesthesia profession and their patients, Baxter Healthcare Corporation continues to support the work of the PostopQRS Scientific Advisory Board through multiple efforts.

The original aims for the group were to:

  1. Agree on a quality of recovery scoring system to measure both short- and long-term recovery
  2. To develop this into a validated assessment tool for clinical research or institutional audit
  3. To develop this into an audit tool for clinicians to assess their own practice

Following a vast literature search it was determined that recovery should be measured in multiple domains and extend beyond the immediate recovery period. For many anaesthesiologists physiological safety is the paramount concern but the emerging thinking is that "what happens in the operating room may influence recovery well beyond hospital discharge" and ties in well with techniques and protocols to enhance recovery after surgery. The group agreed that a baseline recording would be required and then immediate, early, late and long-term assessments would be performed. It was also agreed that the final tool must be useable in any clinical setting for any procedure anywhere in the world and that it would provide data which could be used for clinical trials and also for simple audit processes. The concept of measuring multiple domains of recovery over repeated times enables the researcher to investigate how the different recovery domains interact, as well as the follow-on consequences of poor recovery in one domain on other aspects of recovery.

The objectives of the group were moved forward though a Delphi process and open debate. It was recognised that pilot studies would have to be performed using a new tool which could then be refined and utilised on a boarded base. It was the aims of the group to develop a new tool that would measure and demonstrate quality of recovery in multiple domains and which was formally validated, suitably sensitive and practical for use in clinical practice. Having refined the tool and including a cognitive recovery component the Board agreed on a study protocol for pilot studies to be conducted in Canada, USA, France, Australia, Germany, UK, Mexico and China. After an initial pilot study of 133 patients, the PostopQRS tool was revised to its current form and a validation study of 701 participants was conducted to establish feasibility and face validity. The feasibility and face validation manuscript was accepted and published in 2010 in Anesthesiology.

A number of projects have since been performed or are in progress to provide additional levels of validation. A sub analysis on satisfaction has been published in the European Journal of Anaesthesiology​. Ongoing development has included further validation studies to identify normal cognitive performance variability, as well as discriminant validation studies to show that the PostopQRS is able to discriminate change between groups.

The PostopQRS has been previously released for general use free of charge and to date has been issued to over 50 users, with a number of studies underway around the world. The tool will soon be transitioning to a paid for service to help support the provision of this resource to the various classes of end users. The original PostopQRS group has been replaced with a smaller PostopQRS Scientific Advisory Board who oversees tool validation and development. It is our ideal that many researchers around the world will use the PostopQRS as a measurement of patient-focused outcome after surgery and anaesthesia. By facilitating data entry and analysis the online tool will not only be more attractive to researchers and those interested in auditing their practice but opens the possibility of real-time feedback on patient recovery.

Key members of the PostopQRS Scientific Advisory Board

  1. Professor Colin Royse (Chair) is based at the University of Melbourne and the Royal Melbourne Hospital in Australia.
  2. Professor Stanton Newman is the Dean of Health Sciences at City, University of London, UK.
  3. Professor Franco Carli is professor of anaesthesia at McGill University in Montréal, Canada, and a key member of the Enhanced Recovery After Surgery (ERAS) group.
  4. Professor Jan Jakobsson is professor of anaesthesiology at the Department of Physiology and Pharmacology at the Karolinska Institute, Stockholm, Sweden.
  5. Associate Professor Zhongcong Xie is associate professor of anaesthesia at the Harvard medical school, and Massachusetts Gen Hospital.