Day surgery patients assessment of pain

Introduction

A modified version of the instrument Quality of Recovery – 40 (QoR-40) was developed to assess quality of recovery in a Swedish group of day surgery patients. The relevance of the original 40 items for day surgery patients in a Swedish context were assessed which were modified to 27 items and one general question about pain. After psychometric tests, three out of four dimensions showed initial support viz, emotional state, physical comfort and physical independence, altogether 23 items. The original version of QoR-40 contained several item, n= 7, to assess a pain dimension. Our modified version reduced the pain dimension to one general item to address minor surgery and avoid focusing on so many different pain symptoms. We now want to scrutinize if that rationale was well motivated.

Aim

This study aimed to examine whether seven items on pain are motivated to aggregate in a modified, less comprehensive, instrument to assess the quality of recovery after day surgery.

Method

A sample of 201 patients that underwent a day surgical procedure answered a short questionnaire at discharge concerning “wound pain”, “headache”, “muscle pains”, “backache”, “sore throat” and “sore mouth” on a 5-point scale from none of the time to all of the time. A question about “pain right now” on an 11-point scale was added, no pain to worst possible pain.

Results

The respondents’ mean age was 50 years, and 48% were male. They had undergone general (30%), orthopaedic (28%), hand (32%), and urological (10%) day surgery procedures. General anaesthesia was given to 75% of the patients, and 25% were given local anaesthesia.
In five of six pain items (scored 1-5), more than 90% of the patients gave scores of 1 (not at all) or 2. Concerning wound pain, 69% gave scores of 1 or 2. The mean (SD) score for pain right now (11-point scale) was 2.2 (2.0).  The correlation coefficient between wound pain and pain right now was 0.74.

Conclusion

Including seven items in a pain dimension for this group of patients appears to be unmotivated. We suggest including one item focused on wound pain in the physical comfort dimension. Consequently, the modified quality-of-recovery instrument would consist of 24 items (QoR-24) in three dimensions.