Quality of recovery from anesthesia in neurosurgical patients

Background: Factors influencing quality of recovery in cranial and spinal neurosurgical patients are not known, possibly because of lack of a suitable instrument. Therefore, the authors measured quality of recovery using the QoR-40 score (a 40-item questionnaire on quality of recovery from anesthesia). Methods: With informed consent, 200 patients undergoing elective neurosurgery were recruited. The QoR-40 score, visual analog scores for pain and quality of recovery, and data on complications were collected over 90 days. The psychometrics of the QoR-40 were tested and regression models were developed to determine predictors of quality of recovery and postoperative pain. Results: The QoR-40 score demonstrated significant responsiveness, validity, and reliability. In cranial surgery patients, QoR-40 scores were lower on days I and 2 than either preoperatively or on days 3, 30, and 90. In spinal surgery patients, QoR-40 scores were lower preoperatively and on days I and 2 than on days 3, 30, and go. Longer duration of surgery, more complications, and higher visual analog scores for pain were predictors of poor quality of recovery on day 3. Cranial surgery patients had moderately severe pain on days I and 2, whereas spinal surgery patients reported moderate pain for the whole study period. Neurologic deficits were negatively correlated with QoR-40 scores in cranial and spinal surgery patients. Conclusions: The QoR-40 score is a useful instrument with which to assess quality of recovery in cranial and spinal surgery patients. Postoperative pain and neurologic deficits correlate with poor quality of recovery in these patients.