Postoperative recovery in daysurgery Evaluation of psychometric properties and clinical usefulness of a questionnaire in day surgery

Abstract: Background: Day surgery has increased during recent decades in many countries and represents approximately 50% of surgical procedures performed in Sweden. Day surgery implies that the patient is admitted and operated on during the same day and discharged without an overnight stay at the surgery unit. Undergoing a day surgical procedure thereby means that the major part of the postoperative recovery takes place in the patient’s home, leaving the patient and his/her supportive network responsible for the postoperative care. Day surgery also implies that health care professionals have to adapt to outpatient care and find valid measurements for monitoring a patient’s recovery progress after discharge.Aims: The aim of Study I was to evaluate the psychometric properties of a translated version of the Post-discharge Surgical Recovery (PSR) scale in a Swedish day surgery sample in terms of data quality, internal consistency, dimensionality and responsiveness. The aim of Study II was to describe postoperative recovery on postoperative days 1, 7 and 14 after different orthopaedic day surgical procedures, as well as to identify possible predictors associated with postoperative recovery two weeks after surgery.Methods: Six-hundred and seven patients who had undergone an orthopaedic surgical procedure (n=358), general surgery (n=182) or gynaecological surgery (n=67) were included. To assess postoperative recovery, the PSR scale and the emotional state, physical comfort and physical independency dimensions of the Quality of Recovery-23 (QoR-23) were used. In addition, patients’ background data and self ratings of their ability to work or handle usual business and general health were obtained. Data were collected preoperatively and on postoperative days 1, 7 and 14. In Study I data quality and internal consistency were evaluated using descriptive statistics, correlation analyses and Cronbach’s alpha. The dimensionality was determined using an exploratory factor analysis, and the responsiveness was evaluated through the standardized response mean (SRM) and the area under the receiver operating characteristics curve (AUC). In Study II, patients’ postoperative recovery and general health were compared over time using Friedmann’s ANOVA and between surgical groups of patients using the Kruskal-Wallis test. To determine predictors of recovery, a multiple linear regression analysis was performed with the PSR score on postoperative day 14 as the dependent variable.Results: In Study I, two items were deleted from the Swedish version of the PSR scale. This was based on several low inter-item (<0.30) and item-total correlations (<0.40) and substantial ceiling effects (65%). After the deletion of two items, the Cronbach’s coefficient alpha was 0.90 and the average interitem correlation was 0.44. According to the factor analysis, a single dimension was found explaining the common variance to 44%. The SRM (1.14) indicated a robust ability to detect changes in recovery. The AUC was 0.60 for the entire scale, but varied (0.58-0.81) when the PSR score on postoperative day 1 was categorized into three intervals. In Study II, the shoulder patients experienced significantly lower postoperative recovery and general health one and two weeks after surgery (p<0.001). Significant predictors of recovery on postoperative day 14 were age, perceived health and emotional status on postoperative day 1 and type of surgery, and explained the dependent variable to 33%.Conclusions: The Swedish version of the PSR scale seems to be a consistent and valid instrument for the assessment of postoperative recovery at home in Sweden. The recovery process for orthopaedic day surgery patients differs, with shoulder surgery patients in particular showing poor recovery, which could be considered when day surgery patient education programmes are developed.