Psychometric evaluation of the modified quality of recovery score for the postanaesthesia care unit (QoR-PACU2) – a prospective validation study

Background To date, there is no instrument to adequately assess self-reported quality of recovery (QoR) in the post-anesthesia care unit (PACU). We previously developed the QoR-PACU, a 13-item questionnaire specifically applicable to the PACU. The feasibility, acceptance, and validity of the QoR-PACU were promising. However, measures of reliability were slightly lower than expected. Methods We modified the QoR-PACU and evaluated its psychometric properties in a cohort of adult patients scheduled for non-cardiac surgery with general anesthesia. The modified QoR-PACU (termed QoR-PACU2) was administered before surgery and postoperatively in the PACU at the time of the decision to discharge. Results A total of 307 patients were included in the final analysis. Postoperative QoR-PACU2 sum scores differed across categories of sex, perioperative and surgical risk, and modes of airway management. The duration of anesthesia and surgery, maximum pain intensity and analgesic requirement in the PACU, and length of PACU stay were all inversely correlated with QoR in the PACU. Cronbach’s alpha was 0.70 (95%CI: 0.66 to 0.75). The intra-class correlation coefficient was 0.86 (95%CI: 0.70 to 0.94, p < 0.001) for intra-rater reliability (n=24) and 0.94 (95%CI 0.90 to 0.97, p < 0.001) for inter-rater reliability (n=31). Cohen’s effect size was 0.68 and the standardized response mean was 0.57. Conclusion The QoR-PACU2 assesses self-reported QoR after surgery in the PACU. Measures of feasibility, validity, and reliability were consistently high. Measures of responsiveness were moderate, which might be attributable to the heterogeneity of the study population. Future studies should include aspects of ethnicity and cross-cultural applicability.