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

1. What is PostopQRS?

The Post-operative Quality of Recovery Scale (PostopQRS) is a measurement tool to quantify quality of recovery after surgery and anaesthesia. It is comprised of a number of questions that objectively measure patient recovery, which are clustered into five different domains (physiological, emotive, nociceptive, activities of daily living, and cognitive) and one self-assessment domain. It has been designed to measure recovery over multiple time periods. The target use for the PostopQRS research and audit of practice.

2. How is the PostopQRS conducted?

The PostopQRS is conducted by an investigator asking a series of questions to the patient. These can be conducted face-to-face, or over the telephone. Typically, the baseline (pre-surgery) and in-hospital tests are performed face-to-face, but after hospital discharge, it is conducted over the telephone.

3. How long does it take to conduct the PostopQRS?

It takes approximately 5 to 6 minutes to conduct the PostopQRS survey on each occasion.

4. What is meant by the term "recovery"?

Recovery means that the patient has returned to their pre-surgery state, or has improved from that. To quantify this, the post operative value for each test is subtracted from the baseline value, and if the difference is = 0, then the patient is scored as recovered. The exception to this rule is for the cognitive domain, where we introduce a tolerance factor to account for normal performance variability in cognitive tests. The patients can perform a little bit worse than baseline in the cognitive domain and still be scored as recovered. Recovery is then scored for each domain, and patients must recover in all tests within the domain to be scored as recovered. "All domains" recovery implies recovery in all of the five recovery domains. The self-assessment domain is not strictly a recovery domain as it does not have a baseline value. Rather, this domain is used to identify the patient's subjective opinions about the recovery process, including satisfaction.

5. When do we conduct the PostopQRS?

All patients must have a pre-surgery PostopQRS assessment, as it captures the baseline state of the patient. After surgery, the investigator can determine when to measure recovery, according to the type of surgery, type of intervention, and length of follow-up that they wish to evaluate. There are four major time periods of the valuation that will look at different aspects of recovery:

  1. Immediate: this is conducted within 10 to 30 minutes after the end of anaesthesia delivery. The primary focus is on physiological and nociceptive recovery.
  2. Early: this is conducted within the first few hours after surgery, and is often performed just prior to discharge from the PACU or on return to the ward. This time point measures physiological recovery as well as early nociceptive and emotive, and cognitive recovery.
  3. Late: this is conducted in the first week after surgery (there may be several measurements during this period). The focus shifts from physiological recovery to nociceptive, emotive, cognitive, and functional (activities of daily living) recovery, as well as documenting patient self-assessment including satisfaction.
  4. Long term: this is typically conducted months after surgery and examines long-term recovery in all domains other than physiological.
  5. Additional time points: this is at the discretion of the investigator.

6. Is it free to use?

The PostopQRS tool has been initially available to researchers without cost. This facility will soon transition to a paid for service to support the provision of this resource. For now, in order to access it, you need to​ sign up as a user and accept the terms and conditions. The most important condition of use is that the tool is not modified by the user. You may vary the times that it is used, but we ask that you do not alter the question set. We do request that when you submit your ethics applications that you seek permission for us to analyse anonymous data. This will allow us to produce benchmark data for different operations and for different countries. This will provide an added service to you, as you will be able to compare how your centre/technique compares with national or international data.

7. How do I analyse the data?

You will be able to export your data into a format that can be analysed using conventional statistical packages. Information on scoring recovery data is available on the members homepage. You may need to seek statistical advice on how best to analyse this type of data. Alternatively, you may contact members of the PostopQRS scientific committee for advice.

8. Who controls the PostopQRS?

The PostopQRS programme is operated by City, University of London, through the PostopQRS scientific advisory board who oversee the scientific development of the PostopQRS and manages the data within the website database. The scientific advisory board is also a useful resource for potential users to help guide the setup and analysis of studies. Baxter Healthcare had been instrumental in the PostopQRS process by providing unrestricted funding for the development of the PostopQRS and website. They are not, however, involved in the scientific aspects of the PostopQRS. Please see ‘Development of the PostopQRS’.

9. Can I collect additional data?

Once you sign-up to PostopQRS-online, you will have access to a primary dataset which includes patient demographics and surgical and anaesthetic details. You can select which questions from the core dataset you want to include in your research and you can also add your own study-specific questions. If you choose to use your own patient data set, then you would need to record that separately in your own spreadsheet or database, and simply use the PostopQRS website to enter data for the PostopQRS surveys.

10. How do I get started?

In order to get access to the PostopQRS materials, you will need to sign up as a user and accept the terms and conditions of use. You will then have access to entering the data, as well as access to the training package. It is important, that all users of the PostopQRS read through and become familiar with the training package. This is designed to improve consistency of use with the tool. In the training package, there is a step-by-step guide on how to enter the data. Resources such as the "Faces chart" can be downloaded and printed by you to give to patients.

11. Can my whole group get access to the PostopQRS database?

The data entry is designed for either an individual user, or a group of researchers. When you set up your user profile, you will be able to assign other members of the group. This will allow you and your group members to access your study for both data entry as well as analysis.

12. Can anyone else see our data?

Users are restricted to seeing their own data only. When developed, you will have access to benchmark data at a national or international level. However, any such data output will be completely de-identified, other than the country of origin. All data entry to the PostopQRS must be de-identified at the point of data entry. This provides privacy protection to patients. You will need to keep any re-identifying records within your own database or filing system.

13. If I need help with the PostopQRS, whom do I ask?

Basic information about research can often be sourced from your local institution. However, if you have questions specifically related to the PostopQRS, please send us an email through the "Contact us" tab. This will be forwarded to one of the members of the PostopQRS scientific committee who will contact you to discuss the query.