Postoperative Quality of Recovery Scale

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

CE Mark

PostopQRS™ is a digital measurement tool, aka an electronic Clinical Outcomes Assessment (eCOA) solution that is CE Marked as a Class 1 Medical Device within the UK and Europe to assess multiple domains of post-operative recovery over time.

Low-baseline Cognition Algorithm Update

Dear colleagues

As an enrolled user, we are pleased to inform you of a recent development with PostopQRS™. We have updated the cognitive scoring algorithm so that patients with low baseline cognition can now be scored. The following paper is the published validation work behind this change, click here to view the paper.


The proportion of patients with low baseline cognition can be quite high, particularly in elderly patients undergoing complex surgery. These patients may be the most vulnerable to incomplete recovery post-surgery. The current scoring algorithm automatically scores a patient as “recovered” if their baseline cognitive score is equal to or less than the “tolerance factor”; a factor which accounts for normal daily cognitive performance variability. Patients with low baseline cognition have to be excluded from scoring to prevent a false score being given. We have undertaken validation studies so that we can now measure recovery in these excluded patients. Patients with low baseline scores in the cognitive domain are instead scored according to the number of tests where they are “low baseline”. “Recovery” is achieved if the number of low baseline tests after surgery is less than or equal to the number of low baseline cognitive tests prior to surgery. This is explained in much greater detail in the enclosed paper. For patients with normal baseline cognition, the current scoring algorithm remains unchanged.

How this will impact you:

The raw data entered, and the actual survey items, will not change. As per our current method, you are still able to export the raw data into Excel spreadsheet format. What is changing, is the processing of the raw data for scoring the cognitive domain and all domain sections. The data outputs where recovery is scored, including the figures and tables, will reflect the new cognitive scoring algorithm. Patients with low baseline cognition can still be identified from the data outputs, but they will now be scored for the cognitive and all domain categories.

Date of release:

The system will be updated on Tuesday 16 July at 10:00 GMT to PostopQRS Release 1.0.0 during which time the system will be off-line for several hours. If you wish to preserve any of the current scored data outputs, we recommend that you export the data into the relevant spreadsheet before the new system is updated. The changes will not affect any of your current data in any of your studies. We are very excited by this release as it now allows cognitive and all domain scoring for the most vulnerable of patients undergoing surgery. We trust that you are still using PostopQRS™ and are continuing to find it useful. We hope you will complete our feedback questionnaire on your use of PostopQRS™ that will be sent out shortly, and thank you for your time.

News & Publications

Welcome to the PostopQRS news section. In this section, we will provide updates on new PostopQRS publications or presentations at major conferences. You will also find updates on the development of the PostopQRS.

PostopQRS publications

  1. Boggett S, Ou-Young J, Heiberg J, De Steiger R, Richardson M, Williams Z, Royse C. A randomized trial of desflurane or sevoflurane on postoperative quality of recovery after knee arthroscopy. PLoS One 2019;14:e0220733.
  2. Royse CF. The patient's surgical journey and consequences of poor recovery. Best Pract Res Clin Anaesthesiol 2018;32:253-8.
  3. Ni J, El-Ansary D, Heiberg J, Shen G, You Q, Gao Y, Liu K, Ke H, Royse CF. Validation of a revised Mandarin Chinese language version of the Postoperative Quality of Recovery Scale. Anaesth Intensive Care 2018;46:278-89.
  4. Lin T, Meng Y, Li T, Jiang H, Gao R, Zhou X. Predictors of Postoperative Recovery Based on Health-Related Quality of Life in Patients after Degenerative Lumbar Scoliosis Surgery. World Neurosurg 2018;109:e539-e45.
  5. Diab MS, Bilkhu R, Soppa G, Edsell M, Fletcher N, Heiberg J, Royse C, Jahangiri M. The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study. J Thorac Cardiovasc Surg 2018;156:1906-15 e3.
  6. Bowyer AJ, Heiberg J, Sessler DI, Newman S, Royse AG, Royse CF. Validation of the cognitive recovery assessments with the Postoperative Quality of Recovery Scale in patients with low-baseline cognition. Anaesthesia 2018;73:1382-91.
  7. Bowyer A, Royse C. Approaches to the measurement of post-operative recovery. Best Pract Res Clin Anaesthesiol 2018;32:269-76.
  8. Bowyer A, Royse C. A matter of perspective - Objective versus subjective outcomes in the assessment of quality of recovery. Best Pract Res Clin Anaesthesiol 2018;32:287-94.
  9. Bowyer A, Royse C. The future of recovery - Integrated, digitalised and in real time. Best Pract Res Clin Anaesthesiol 2018;32:295-302.
  10. Biscaia A, Amorim P, Esteves S, Lagarto F, Gomes B, Bismarck J, Rodrigues N, Nogueira M, Royse CF. Validation of the Portuguese Version of the Postoperative Quality Recovery Scale (PostopQRS). Acta Med Port 2018;31:551-60.
  11. Terkawi AS, Tsang S, Riad W, Nassar SN, Mahmoud M, AlKahtani GJ, Alsharif HH, Doais KS, Sala FJ, Abdulrahman A, Royse CF. Development and validation of Arabic version of the postoperative quality of recovery scale. Saudi J Anaesth 2017;11:S19-S30.
  12. Terkawi AS, Myles PS, Riad W, Nassar SN, Mahmoud M, AlKahtani GJ, Sala FJ, Abdulrahman A, Doais KS, Terkawi RS, Tsang S. Development and validation of Arabic version of the postoperative quality of recovery-40 questionnaire. Saudi J Anaesth 2017;11:S40-S52.
  13. Royse CF, Saager L, Whitlock R, Ou-Young J, Royse A, Vincent J, Devereaux PJ, Kurz A, Awais A, Panjasawatwong K, Sessler DI. Impact of Methylprednisolone on Postoperative Quality of Recovery and Delirium in the Steroids in Cardiac Surgery Trial: A Randomized, Double-blind, Placebo-controlled Substudy. Anesthesiology 2017;126:223-33.
  14. Royse CF, Clarke S. Satisfaction is not substantially affected by quality of recovery: different constructs or are we lost in statistics? Anaesthesia 2017;72:1064-8.
  15. Katijjahbe MA, Denehy L, Granger CL, Royse A, Royse C, Bates R, Logie S, Clarke S, El-Ansary D. The Sternal Management Accelerated Recovery Trial (S.M.A.R.T) - standard restrictive versus an intervention of modified sternal precautions following cardiac surgery via median sternotomy: study protocol for a randomised controlled trial. Trials 2017;18:290.
  16. Brumby AM, Heiberg J, Te C, Royse CF. Quality of recovery after gastroscopy, colonoscopy, or both endoscopic procedures: an observational pilot study. Minerva Anestesiol 2017;83:1161-8.
  17. Jildenstal P, Eriksson J, Warren Stomberg M, Jakobsson JG. Evaluation of the Postoperative Quality of Recovery Scale test and re-test in Swedish among healthy volunteers. F1000Res 2016;5:2549.
  18. Bowyer AJ, Royse CF. Postoperative recovery and outcomes--what are we measuring and for whom? Anaesthesia 2016;71 Suppl 1:72-7.
  19. Bowyer A, Royse CF. The future of postoperative quality of recovery assessment: multidimensional, dichotomous, and directed to individualize care to patients after surgery. Curr Opin Anaesthesiol 2016;29:683-90.
  20. Bowyer A, Royse C. The importance of postoperative quality of recovery: influences, assessment, and clinical and prognostic implications. Can J Anaesth 2016;63:176-83.
  21. Naito Y, Tanaka Y, Sasaoka N, Iwata T, Fujimoto Y, Okamoto N, Inoue S, Kawaguchi M. Feasibility, reliability, and validity of the Japanese version of the Postoperative Quality of Recovery Scale: a first pilot study. J Anesth 2015;29:463-6.
  22. Royse CF, Williams Z, Ye G, Wilkinson D, De Steiger R, Richardson M, Newman S. Knee surgery recovery: Post-operative Quality of Recovery Scale comparison of age and complexity of surgery. Acta Anaesthesiol Scand 2014;58:660-7.
  23. Royse CF, Williams Z, Purser S, Newman S. Recovery after nasal surgery vs. tonsillectomy: discriminant validation of the Postoperative Quality of Recovery Scale. Acta Anaesthesiol Scand 2014;58:345-51.
  24. Newman S, Wilkinson DJ, Royse CF. Assessment of early cognitive recovery after surgery using the Post-operative Quality of Recovery Scale. Acta Anaesthesiol Scand 2014;58:185-91.
  25. Liu J, Yuan W, Wang X, Royse CF, Gong M, Zhao Y, Zhang H. Peripheral nerve blocks versus general anesthesia for total knee replacement in elderly patients on the postoperative quality of recovery. Clin Interv Aging 2014;9:341-50.
  26. Bowyer A, Jakobsson J, Ljungqvist O, Royse C. A review of the scope and measurement of postoperative quality of recovery. Anaesthesia 2014;69:1266-78.
  27. Amorim P, Lagarto F, Gomes B, Esteves S, Bismarck J, Rodrigues N, Nogueira M. Neostigmine vs. sugammadex: observational cohort study comparing the quality of recovery using the Postoperative Quality Recovery Scale. Acta Anaesthesiol Scand 2014;58:1101-10.
  28. Royse CF, Newman S, Williams Z, Wilkinson DJ. A human volunteer study to identify variability in performance in the cognitive domain of the postoperative quality of recovery scale. Anesthesiology 2013;119:576-81.
  29. Royse CF, Chung F, Newman S, Stygall J, Wilkinson DJ. Predictors of patient satisfaction with anaesthesia and surgery care: a cohort study using the Postoperative Quality of Recovery Scale. Eur J Anaesthesiol 2013;30:106-10.
  30. Lindqvist M, Royse C, Brattwall M, Warren-Stomberg M, Jakobsson J. Post-operative Quality of Recovery Scale: the impact of assessment method on cognitive recovery. Acta Anaesthesiol Scand 2013;57:1308-12.
  31. Royse CF, Newman S, Chung F, Stygall J, McKay RE, Boldt J, Servin FS, Hurtado I, Hannallah R, Yu B, Wilkinson DJ. Development and feasibility of a scale to assess postoperative recovery: the post-operative quality recovery scale. Anesthesiology 2010;113:892-905.

Language translations

The PostopQRS is now available in the following languages.

  1. English
  2. French
  3. German (new release to be issued soon) 
  4. Spanish (covering US Spanish)
  5. Arabic 
     Beta Version available on request
    Beta Version available on request
  6. Portuguese (new release to be issued soon)
  7. Mandarin (new release to be issued soon)
  8. Japanese (new release to be issued soon)
  9. Greek (under development)
  10. Bahasa Malaysian  (under development)

Community of users

PostopQRS has now been registered to over 350 Users worldwide. We look forward to welcoming new Users to the PostopQRS Community.