The future of postoperative quality of recovery assessment: multidimensional, dichotomous, and directed to individualize care to patients after surgery

Abstract

Purpose of review: Recovery after surgery is a complex interplay of the patient, the surgery, and the perioperative anaesthesia management. Assessment of recovery should address the needs of multiple stakeholders, including the institutions and healthcare providers, but primarily should be focused on the patients and their perception of quality of recovery and return to normalcy. This review will summarize the development of assessment of recovery to a multidimensional dichotomous construct that requires a real-time assessment tool validated for repeat measures and containing cognitive assessment.

Recent findings: Recovery is neither defined by a single composite number nor is it quantified at a single time point, but rather it is a continuum occurring in multiple domains and over periods of time from hours, to days to weeks or months after surgery. Recovery is often incomplete which may persist long term, leading to patient suffering, loss of work, and increased demands on family and healthcare providers long after apparently successful surgery. The important correlation between poor recovery, cognitive decline, institutional placement, and increased short and long-term mortality has been hampered by the heterogeneity of definitions and tools used and their assessment of recovery as a continuous vs. dichotomous score and at the group vs. individual level. Most research has been aimed at audit or group comparison rather than attempting to identify incomplete recovery at an early time period after surgery in specific patients and individualization of care based on the domain where recovery has failed.

Summary: Recovery is best defined as a multidimensional dichotomous construct encompassing nociceptive, emotive, functional, and cognitive domains. Its assessment tool should provide both real-time and restrospective recovery data, thus enabling clinical and research applications, and be validated for repeat measures over a breadth of multiple clinically relevant postoperative time points.