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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Abola, Ramon E., MD*; Bennett-Guerrero, Elliott, MD*; Kent, Michael L., MD; Feldman, Liane S., MD; Fiore, Julio F. Jr, PhD; Shaw, Andrew D., MB§; Thacker, Julie K. M., MD; Gan, Tong J., MD*; Miller, Timothy E., MB, ChB, FRCA; Hedrick, Traci L., MD, MS; McEvoy, Matthew D., MD; Mythen, Michael G., MBBS, MD, FRCA, FFICM, FCAI (Hon); Bergamaschi, Roberto, MD, PhD; Gupta, Ruchir, MD; Holubar, Stefan D., MD, MS; Senagore, Anthony J., MD, MS, MBA; Wischmeyer, Paul E., MD, EDIC; Carli, Franco, MD, MPhil; Evans, David C., MD, FACS; Guilbert, Sarah, RD, LDN, CNSC; Kozar, Rosemary, MD, PhD; Pryor, Aurora, MD, FACS; Thiele, Robert H., MD; Everett, Sotiria, EdD, RD; Grocott, Mike for the Perioperative Quality Initiative (POQI) 2 Workgroup

doi: 10.1213/ANE.0000000000002758
Perioperative Medicine: Narrative Review Article

Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2–3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.

From the *Department of Anesthesiology, Stony Brook Medicine, Stony Brook, New York

Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina

Department of Surgery, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada

§Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee

Department of Surgery, Duke University Medical Center, Durham, North Carolina.

Assistant Professor of Surgery, Co-Director Enhanced Recovery Program, Department of Surgery, University of Virginia Health System

Associate Professor of Anesthesiology, Vanderbilt University School of Medicine, Vice Chair for Educational Affairs, Department of Anesthesiology, Vanderbilt University Medical Center

Smiths Medical Professor of Anesthesia, University College London/University College London Hospital National Institute of Health Research Biomedical Research Centre, London, United Kingdom

Professor of Surgery, Division of Colon and Rectal Surgery, State University of New York, Stony Brook, NY

Assistant Professor of Anesthesiology, Stony Brook School of Medicine, Health Science Center, Stony Brook, NY

Director, Dartmouth Enhanced Recovery Program, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, The Dartmouth Institute for Health Policy and Clinical Practice

Professor and Vice Chair for Clinical Operations, Chief, Gastrointestinal and Oncologic Surgery, Co-Director Department of Surgery Clinical Outcomes Research Program, University of Texas Medical Branch

Professor of Anesthesiology and Surgery, Director of Perioperative Research, Duke Clinical Research Institute, Director, Nutrition Support Service, Duke University Hospital, Duke University School of Medicine, Durham, NC

Professor of Anesthesia, McGill University, Montreal, Quebec, Canada

Associate Professor of Surgery, Medical Director, Level 1 Trauma Center and Nutrition Support Service, Department of Surgery, Division of Trauma, Critical Care, and Burn, Columbus, OH

Clinical Dietitian Duke Nutrition Support Team/Perioperative Nutrition (POET) Clinic, Duke University Hospital, Durham, NC

Director of Research, Shock Trauma, Associate Director of Shock Trauma Anesthesia Research Center, Professor of Surgery, University of Maryland School of Medicine, Baltimore, MD

Professor of Surgery, Chief Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook Medicine, Stony Brook, NY

Assistant Professor, Departments of Anesthesiology and Biomedical Engineering, Divisions of Cardiac, Thoracic, and Critical Care Anesthesiology, Co-Director, University of Virginia Enhanced Recovery After Surgery Program, University of Virginia School of Medicine, Charlottesville, VA

Clinical Assistant Professor, Nutrition Division, Department of Family, Population, Preventive Medicine, Stony Brook Medicine, Stony Brook, NY

Respiratory and Critical Care Research Area, National Institute for Health Research Biomedical Research Centre, University Hospital Southampton, National Health Service Foundation Trust, Southampton, UK and Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom

Published ahead of print December 29, 2017.

Accepted for publication November 3, 2017.

Funding: The Perioperative Quality Initiative meeting received financial assistance from the American Society for Enhanced Recovery.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Members of the Perioperative Quality Initiative (POQI) 2 Workgroup are provided in the Appendix.

Reprints will not be available from the authors.

Address correspondence to Timothy E. Miller, MB, ChB, FRCA, Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to timothy.miller2@duke.edu.

© 2018 International Anesthesia Research Society
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