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Feasibility and Validity of the Quality of Recovery-15 Questionnaire Following Cardiac Surgery: A Prospective Cohort
Terri Sun1, Amir Siddiqui2, Mojtaba Ahmadiankalati3
1Department of Anesthesiology, St. Paul's Hospital, Vancouver, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, Canada; University of British Columbia Faculty of Medicine, Vancouver, Canada.
Objectives:
Few patient-reported outcomes have been validated for immediate postoperative use in cardiac surgery. This study evaluated the feasibility, validity, reliability, and responsiveness of the Quality of Recovery-15 (QoR-15) questionnaire in cardiac surgery patients at 24 hours, 48 hours, and 12 weeks postoperatively.
Design:
Prospective cohort study.
Setting:
St. Paul's Hospital, a tertiary, high-volume cardiac surgical center in Vancouver, Canada.
Participants:
One hundred four adults undergoing elective cardiac surgery.
Interventions:
Participants completed the QoR-15 questionnaire at baseline, at 24 and 48 hours after extubation, and at 12 weeks postoperatively; the 12-week assessment was conducted by telephone.
Measurements And Main Results:
Feasibility was assessed using completion rates and time to completion. Validity was evaluated through correlations with visual analog scale (VAS) recovery scores, demographic and surgical factors, opioid consumption, duration of mechanical ventilation, hospital length of stay (LOS), days alive and at home at 30 days (DAH-30), and Comprehensive Complication Index. Reliability was assessed using intraclass correlation coefficients (ICCs), and responsiveness was assessed using the Cohen effect size and standardized response mean (SRM). Completion rates were 95% at baseline, 88% at 24 hours, 86% at 48 hours, and 68% at 12 weeks. Independent completion occurred in 24% and 40% of patients at 24 and 48 hours, respectively. Mean QoR-15 scores (± standard deviation) decreased at 24 hours (83 ± 22) and 48 hours (96 ± 22) but exceeded baseline scores at 12 weeks (129 ± 16). Responsiveness was excellent at 24 hours (effect size, 1.64; SRM, 1.84) and 48 hours (effect size, 1.04; SRM, 0.92). QoR-15 scores correlated with VAS recovery score, DAH-30, and LOS and varied with aortic cross-clamp duration. Reliability was poor at 24 hours (ICC, 0.30) but good at 48 hours (ICC, 0.81).
Conclusions:
The QoR-15 questionnaire is feasible, valid, and responsive after cardiac surgery, although its use at 24 hours is limited by reduced independent completion and poor reliability.