Volume 3 • Issue 12 • 1000267 J Anesth Clin Res ISSN:2155-6148 JACR an open access journal Open Access Research Article Butler et al., J Anesth Clin Res 2012, 3:12 DOI: 10.4172/2155-6148.1000267 *Corresponding author: Stephen F. Butler, Infexxion, Inc., 320 Needham St., Suite 100, Newton, MA 02464, Tel: 617-332-6028; Fax: 603-672-3162; E-mail: sfbutler@infexxion.com Received November 28, 2012; Accepted December 27, 2012; Published January 02, 2012 Citation: Butler SF, Black RA, Techner L, Fernandez KC, Brooks D, et al. (2012) Development and Validation of the Post-Operative Recovery Index for Measuring Quality of Recovery after Surgery. J Anesth Clin Res 3:267. doi:10.4172/2155- 6148.1000267 Copyright: © 2012 Butler SF, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Development and Validation of the Post-Operative Recovery Index for Measuring Quality of Recovery after Surgery Stephen F. Butler 1 *, Ryan A. Black 1 , Lee Techner 2 , Kathrine C. Fernandez 1 , David Brooks 3 , Mollie Wood 1 and Nathaniel Katz 4,5 1 Infexxion, Inc., Newton, USA 2 Cubist Pharmaceuticals, Lexington, USA 3 Brigham and Women’s Hospital, Boston, USA 4 Analgesic Solutions, Natick, USA 5 Tufts University School of Medicine, Boston, USA Keywords: Symptom measurement; Post-operative recovery; Quality of life Introduction Optimizing the care and assisting in the recovery of patients afer surgery as well as reduction of hospital stay time require the measurement of appropriate outcomes and symptoms through evaluation systems that quantify patients’ post-operative health status. While a number of evaluation systems have been developed to assess a diversity of outcomes [1-5] there is an unmet need for a practical, patient self-report, comprehensive measure of recovery following surgery. Evaluation of this type of scale would need to include the following criteria [6]: appropriateness, reliability, validity, sensitivity to change, precision, interpretability, acceptability and feasibility. A review [6] of existing post-operative recovery scales shows that only one instrument, the 40-item Quality of Recovery (QoR-40) [7] meets the eight criteria; However, this scale is validated only for the immediate (within one day) postoperative period. Several studies have attempted to measure specifc symptoms and signs afer specifc types of surgery [8-12]; however, few have attempted to develop a brief, reliable, multidimensional self-report measure for assessing post- operative recovery applicable to a broad range of surgeries and that can accommodate the entire post-operative course, from a few hours following surgery to complete recovery. One existing instrument is the 27-item Convalescence And Recovery Evaluation (CARE) tool, which assesses four domains identifed through factor analysis (pain, gastrointestinal, cognitive, and physical activity) [13]. Although this instrument was suitable for immediate post-operative assessment with high test/re-test reliability and moderate to high internal consistency for all domains, it was developed on a small sample of patients (n=96) and it assessed recovery afer only three diferent types of surgery (general, urology-related, and gynecology-related). In the work presented here, we aimed to develop and validate a practical and psychometrically sound assessment, the Post-operative Recovery Index (PoRI), to measure the quality of immediate post-surgical recovery and during the early recovery period (i.e., approximately 30 days following surgery) in patients undergoing a broad range of surgical procedures including open laparotomy, spinal fusion, total-knee replacement, full thoracotomy, and laparoscopic- colon resection. Te goals in this work were to create a PoRI that: (1) uses a self-report format, (2) provides an assessment of the quality of recovery in relevant dimensions, (3) is brief enough for use in typical clinical and research settings, (4) is easy to administer and score, and (5) is psychometrically sound. Tese goals were addressed following a systematic approach consisting of fve sequential studies. Study 1 established an initial pool of post-operative outcome items and content validity of the scale. Study 2 completed a conceptual evaluation of the initial item pool and initial item reduction, resulting in the creation of an alpha version of the PoRI. Te alpha version was empirically evaluated in Study 3 producing a fnal version which was cross validated in Study 4. Finally in Study 5, an exploratory analysis examined the factor structure of the scale to determine the possible presence of a second-order, overall “Recovery” factor (total scale), and a scoring Abstract Purpose: Current methods used to quantify aspects of recovery after surgery and anesthesia tend to be narrowly focused, not patient-rated, or have not been appropriately validated. We set out to develop a quality of recovery score system that is self-report and multi-dimensional, with applicability across various surgeries and surgical settings, from immediately post-surgery through discharge and covering the frst 30 days of recovery. Methods: A Post-operative Recovery Index (PoRI) was validated on 225 patients (N Validation =96; N Cross Validation =129) who had undergone a surgical procedure within the last 30 days. Domain level internal consistency on the validation and cross validation samples yielded coeffcients ranging from α=0.813 to α=0.932, while test-retest reliability yielded stability coeffcients ranging from r=0.660 to r=0.881. Confrmatory factor analyses demonstrated validity of the factorial structure of the 37-item PoRI on the validation patient sample and confrmed on the cross validation patient sample. Exploratory psychometric analyses provided evidence of an overarching (second-order) “Recovery” factor. Results: We developed, tested, validated, and cross validated the Post-operative Recovery Index (PoRI) consisting of 37 items assessing symptomatology a patient may experience after surgery. Conclusion: The PoRI is offered as a valid, multidimensional measure of recovery after surgery and anesthesia with broad applicability in post-surgical settings. J o u r n a l o f A n e s t h e s i a & C l i n i c a l R e s e a r c h ISSN: 2155-6148 Journal of Anesthesia & Clinical Research