A prospective clinical audit to evaluate postoperative quality of recovery in adults at New Somerset Hospital, Cape Town, South Africa

Abstract

Background. Recent developments in perioperative medicine increasingly emphasise patient-centred approaches to quality of care metrics. To this end, the 15-item Quality of Recovery (QoR-15) scale is a well-validated and widely applied patient-centred measure of perioperative service quality.

Objectives. To assess quality of recovery in a South African (SA) population by applying the QoR-15 and to identify the local contributors to poor quality of recovery.

Methods. A prospective observational study was performed in all adults undergoing elective and emergency surgery during daytime hours over a 2-week period in February 2019 at New Somerset Hospital, Cape Town, SA. Patients were approached by a qualitative interviewer on day 1 post surgery for consented recruitment, collection of demographic information and application of the QoR-15 questionnaire.

Results. Of 193 patients who had surgery, 154 fulfilled our criteria and completed the questionnaire. The median QoR-15 score was 123 out of 150, which is classified as ‘good’, although most patients (35%) fell into the ‘moderate’ category (90 - 121); 59% achieved the patient acceptable symptom state score (≥118). The median scores of the most poorly reported QoR-15 items were 5 for ‘moderate pain’ and 6 for ‘able to return to work or usual home activities’. Poor scoring was not related to anaesthetic modality (p=0.088), surgical discipline (p=0.237), timing of surgery (p=0.717) or obstetric as opposed to non-obstetric patients (p=0.472). Construct validity was supported by a negative correlation with duration of anaesthesia (rho=–0.286; p<0.001) and lack of correlation with age (rho=–0.034; p=0.674).

Conclusions. We found the QoR-15 to be a valid, feasible and acceptable tool for clinical auditing of perioperative service quality in SA. The median QoR-15 score was 123, with the majority of patients reflecting a moderate QoR. We have highlighted areas with potential for improvement and provided recommendations to address these aspects.