Correlation Between Pain Intensity and Quality of Recovery After Video-Assisted Thoracic Surgery for Lung Cancer Resection

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Abstract

Purpose

The Quality of Recovery-15 (QoR-15) questionnaire provides a multifaceted assessment of postoperative recovery, and the resulting score is recommended as an endpoint in clinical studies focused on postoperative pain. We aimed to investigate the correlation between the QoR-15 score and postoperative pain intensity in surgical patients.

Patients and Methods

Adult patients who underwent video-assisted thoracoscopic surgery (VATS) for lung cancer resection and were enrolled in a prospective registry or in a previous prospective study were included in this study. Baseline and perioperative data, including the results of assessment using the Korean version of the QoR-15 (QoR-15K) questionnaire at 48 hours postoperatively, were collected from the database. Correlations between the QoR-15K total score, questionnaire dimensions, and postoperative pain intensity at 48 hours postoperatively were determined using the Spearman correlation coefficient ( ρ).

Results

We analyzed a total of 137 eligible patients. Significant negative correlations were noted between the QoR-15K total score and pain intensity at rest ( ρ = −0.45, 95% confidence interval [CI]: −0.57 − −0.31, P < 0.001) and during coughing ( ρ = −0.55, 95% CI: −0.65 − −0.42, P < 0.001) at 48 hours postoperatively. The pain dimension and pain intensity at 48 hours postoperatively showed significant correlations with physical comfort, emotional state, and physical independence dimensions. Multivariable logistic regression revealed a significant negative association between the pain score at 24 hours postoperatively and good or excellent postoperative recovery.

Conclusion

The results support the impact of postoperative pain on the overall postoperative quality of recovery in patients who underwent VATS for lung cancer resection. Moreover, the QoR-15K score may be considered as a primary endpoint in clinical studies on postoperative pain control.

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Most cited references 32

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The Clavien-Dindo classification of surgical complications: five-year experience.

Pierre A. Clavien, Jeffrey Barkun, Michelle L. de Oliveira … (2009)

The lack of consensus on how to define and grade adverse postoperative events has greatly hampered the evaluation of surgical procedures. A new classification of complications, initiated in 1992, was updated 5 years ago. It is based on the type of therapy needed to correct the complication. The principle of the classification was to be simple, reproducible, flexible, and applicable irrespective of the cultural background. The aim of the current study was to critically evaluate this classification from the perspective of its use in the literature, by assessing interobserver variability in grading complex complication scenarios and to correlate the classification grades with patients', nurses', and doctors' perception. Reports from the literature using the classification system were systematically analyzed. Next, 11 scenarios illustrating difficult cases were prepared to develop a consensus on how to rank the various complications. Third, 7 centers from different continents, having routinely used the classification, independently assessed the 11 scenarios. An agreement analysis was performed to test the accuracy and reliability of the classification. Finally, the perception of the severity was tested in patients, nurses, and physicians by presenting 30 scenarios, each illustrating a specific grade of complication. We noted a dramatic increase in the use of the classification in many fields of surgery. About half of the studies used the contracted form, whereas the rest used the full range of grading. Two-thirds of the publications avoided subjective terms such as minor or major complications. The study of 11 difficult cases among various centers revealed a high degree of agreement in identifying and ranking complications (89% agreement), and enabled a better definition of unclear situations. Each grade of complications significantly correlated with the perception by patients, nurses, and physicians (P < 0.05, Kruskal-Wallis test). This 5-year evaluation provides strong evidence that the classification is valid and applicable worldwide in many fields of surgery. No modification in the general principle of classification is warranted in view of the use in ongoing publications and trials. Subjective, inaccurate, or confusing terms such as "minor or major" should be removed from the surgical literature.

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Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15.

Tricia A. Burke, Daniel Stark, Paul S Myles (2013)

Quality of recovery (QoR) after anesthesia is an important measure of the early postoperative health status of patients. The aim was to develop a short-form postoperative QoR score, and test its validity, reliability, responsiveness, and clinical acceptability and feasibility. Based on extensive clinical and research experience with the 40-item QoR-40, the strongest psychometrically performing items from each of the five dimensions of the QoR-40 were selected to create a short-form version, the QoR-15. This was then evaluated in 127 adult patients after general anesthesia and surgery. There was good convergent validity between the QoR-15 and a global QoR visual analog scale (r = 0.68, P < 0.0005). Construct validity was supported by a negative correlation with duration of surgery (r = -0.49, P < 0.0005), time spent in the postanesthesia care unit (r = -0.41, P < 0.0005), and duration of hospital stay (r = -0.53, P < 0.0005). There was also excellent internal consistency (0.85), split-half reliability (0.78), and test-retest reliability (ri = 0.99), all P < 0.0005. Responsiveness was excellent with an effect size of 1.35 and a standardized response mean of 1.04. The mean ± SD time to complete the QoR-15 was 2.4 ± 0.8 min. The QoR-15 provides a valid, extensive, and yet efficient evaluation of postoperative QoR.

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Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures.

Ib Jammer, Nadine Wickboldt, Michael Sander … (2015)

There is a need for large trials that test the clinical effectiveness of interventions in the field of perioperative medicine. Clinical outcome measures used in such trials must be robust, clearly defined and patient-relevant. Our objective was to develop standards for the use of clinical outcome measures to strengthen the methodological quality of perioperative medicine research. A literature search was conducted using PubMed and opinion leaders worldwide were invited to nominate papers that they believed the group should consider. The full texts of relevant articles were reviewed by the taskforce members and then discussed to reach a consensus on the required standards. The report was then circulated to opinion leaders for comment and review. This report describes definitions for 22 individual adverse events with a system of severity grading for each. In addition, four composite outcome measures were identified, which were designed to evaluate postoperative outcomes. The group also agreed on standards for four outcome measures for the evaluation of healthcare resource use and quality of life. Guidance for use of these outcome measures is provided, with particular emphasis on appropriate duration of follow-up. This report provides clearly defined and patient-relevant outcome measures for large clinical trials in perioperative medicine. These outcome measures may also be of use in clinical audit. This report is intended to complement and not replace other related work to improve assessment of clinical outcomes following specific surgical procedures.

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Author and article information

Journal

Journal ID (nlm-ta): J Pain Res

Journal ID (iso-abbrev): J Pain Res

Journal ID (publisher-id): jpr

Title: Journal of Pain Research

Publisher: Dove

ISSN (Electronic): 1178-7090

Publication date (Electronic): 02 October 2023

Publication date Collection: 2023

Volume: 16

Pages: 3343-3352

Affiliations

[1 ]Department of Anesthesiology and Pain Medicine, Seoul National University Hospital , Seoul, Republic of Korea

[2 ]Department of Anesthesiology and Pain Medicine, Ajou University School of Medicine , Suwon, Republic of Korea

[3 ]Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine , Seoul, Republic of Korea

[4 ]Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital , Seoul, Republic of Korea

[5 ]Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine , Seoul, Republic of Korea

Author notes

Correspondence: Ho-Jin Lee, Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine , 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, Tel +82-2-2072-0039, Fax +82-2-747-8363, Email hjpainfree@snu.ac.kr

[*]

These authors contributed equally to this work

Author information

Soo-Hyuk Yoon http://orcid.org/0000-0002-8484-5777

Jinyoung Bae http://orcid.org/0000-0002-8121-2106

Susie Yoon http://orcid.org/0000-0001-5281-5904

Article

Publisher ID: 426570

DOI: 10.2147/JPR.S426570

PMC ID: 10558582

PubMed ID: 37808464

SO-VID: 1b7cff1c-5635-4839-8dac-0abdf6097281

License:

This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

History

Date received : 18 June 2023

Date accepted : 25 September 2023

Page count

Figures: 0, Tables: 6, References: 33, Pages: 10

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Correlation Between Pain Intensity and Quality of Recovery After Video-Assisted Thoracic Surgery for Lung Cancer Resection

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Most cited references 32

The Clavien-Dindo classification of surgical complications: five-year experience.

Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15.

Standards for definitions and use of outcome measures for clinical effectiveness research in perioperative medicine: European Perioperative Clinical Outcome (EPCO) definitions: a statement from the ESA-ESICM joint taskforce on perioperative outcome measures.

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