Development of a paediatric quality of recovery score

Abstract

Quality of recovery after anaesthesia is an important, multi-faceted end-point that represents the overall health status of a patient after surgery and anaesthesia. It encompasses a patient's perception of return to 'wellbeing', a combination of physical, psychological, emotional and social factors. In the field of adult perioperative medicine, a quality of recovery tool has been developed and extensively validated (the QoR-40 andQoR-15)[1]. It is now one of the standardised outcome measures included in the Standardised Endpoints in Perioperative Medicine (StEP) initiative. To date, no such instrument exists in paediatric perioperative medicine, however the Paediatric Perioperative Outcomes Group has been established to identify and create standardised instruments to report outcomes in children. The aim of this project was to develop a pilot quality of recovery tool, responsive and relevant to paediatric patients' recovery. Methods: Item generation 1. Literature review for key constructs and existing instruments used in the assessment of recovery. 2. Free-thought brainstorming with health care experts and parents for concepts, themes and endpoints relevant to postoperative recovery. 3. Semi-structured interviews with patients and families to identify important aspects of recovery. Selection of items 1. Thematic classification of the items into domains and sub-domains 2. Delphi process to create a shortlist of approximately 50 items to use as a pilot tool to undergo psychometric testing. Results: The literature review of PubMed, search of the grey literature and snowballing references from systematic reviews resulted in the inclusion of 41 adult and paediatric instruments. Free-thought brainstorming with a range of health literate experts was used to expand for missing items or concepts. A sub-group of the authors (WM, PS) conducted semi-structured interviews with stakeholders and focus groups[2]. Information from these steps was assimilated into an item list. 215 items were thematically analysed and matched to 26 conceptual unidimensional sub-domains using the International Classification of Functioning Disability and Health and prior validated instruments. These items were reduced to 92 items (patient/proxy paired questions) after independent review by a sub-group of authors (CG, PLA) evaluating for face validity, ambiguity and responsiveness. A Delphi exercise with 27 respondents (46 invites to health care experts and health literate parents) was conducted asking respondents to rank each of the items in the sub-domains according to: validity, reliability, feasibility, readability/ambiguity and patient centredness. The pilot tool was reduced to 48 items by excluding poorly ranked items (or sub-domains if single items). Discussion: Quality of recovery is a multidimensional construct covering domains of well-being, functioning and postprocedural symptomatology as perceived by the patient and/or carer This tool will be suitable for 2-17 year old children with significantly different developmental and psychological levels, responsive to the whole recovery process, and applicable to the range of procedures children experience. Construction of this tool follows established mixed methods approaches to questionnaire development[3].L6368008252022-01-11 <br />