Quality of care "is the level at which healthcare services provided to people and populations improve desired health outcomes." To achieve this, healthcare must be safe, effective, timely, efficient, equitable, and, above all, patient-centered.1 In anesthesiology, quality of care includes anesthetic care that contributes to the creation of good health outcomes, in this case perioperative outcomes, including reduced frequency of adverse events, shorter recovery time, and greater patient satisfaction.2

In view of the above, it follows that involvement of patient perceptions will provide a unique perspective regarding nontechnical aspects of medical care and will help evaluate services, taking into consideration patient needs and expectations as determinants of healthcare outcome.3-6 At present, patient-centered tools have been developed to assess the quality of patient recovery in postoperative care areas, and reviews are available of the tools that provide the closest measurements of satisfaction with care.7-10

In Colombia, the Quality of Recovery Scale (QRS) was created for measuring the quality of postanesthetic recovery from the patient's perspective. It was developed in a Colombian population for assessing care processes (except for pain) in low-to-intermediate-complexity care units.2 The QRS was used in postoperative periods of 3 specialties: orthopedic, abdominal, or thoracic surgery. According to the results, 80.4% of the patients achieved satisfactory outcomes.11 However, satisfaction in patients of high-complexity specialties has not been assessed. The objectives of this article are to determine patient satisfaction in the Hospital Universitario de la Samaritana (HUS) postoperative care unit (PACU) as a quality indicator of postanesthetic recovery, and to assess the internal consistency and validity of the QRS in a high-complexity reference hospital. The aim is to identify strengths and weaknesses of the care process in the postanesthetic recovery area to create strategies designed to improve quality of care provision.

A cross-sectional descriptive study which followed the local and international recommendations for human research, approved by the Research Sub-Committee of Universidad de La Sabana and the Ethical-Scientific Committee of HUS.

In the end, 154 patients were analyzed and, of them, 51.3% were males. The median age was 52 years (interquartile range: 35-64), the minimum being 15 and the maximum 90; the group between 30 and 70 years of age had the highest representation (60.3%).

In terms of the affiliation to the health insurance system, the vast majority belong to the subsidized regime (91.5%).

In terms of clinical variables, 44.8% of the respondents were found to have an ASA II pre-anesthetic risk. A Lee index lower than 2 was identified in 92.2% of the cases.

Regarding classification by surgical service, patients taken to orthopedic surgery had the highest participation (n = 42), followed by patients taken to general surgery procedures (n = 32), whereas patients of the head and neck specialty had the lowest participation (n=2) (Table 1).

Table 1

ASA=American Society of Anesthesiologists.

For the study population, the average QRS score was 49.2 (Standard Deviation: 4.1), with a minimum of 39 and a maximum of 61. However, of the total number of respondents, 7.14% (n = 11) were satisfied with the quality of recovery (QRS > 56) versus 92.86% (n = 143) who were not satisfied (QRS < 56) (Table 2).

Table 2

ASA=American Society of Anesthesiologists; SD=Standard Deviation.

The mean values for patients who were satisfied and who were not satisfied were 57.64 (Standard Deviation: 1.7) and 48.65 (Standard Deviation: 3.2), respectively. There were no satisfied patients in the population belonging to the contributive health insurance regime. Of the 11 specialties which took patients to interventions or procedures, only 5 had patients who were satisfied (orthopedics, gynecology, general surgery, gastroenterology, and urology).

In terms of differences related to the most relevant characteristics, the Wilcoxon test results for the QRS show a statistically significant difference only between satisfied and not satisfied patients (P < 0.05). There are no statistical differences for patient gender or the type of anesthesia, which signals that the QRS has no effect for those characteristics. The results of the t test for the most relevant characteristics are shown in Table 3.

Table 3

IQR=interquartile range; QRS: Quality of Recovery Scale. Wilcoxon test to determine median differences.

Finally, Cronbach's Alpha test used to determine consistency of the QRS showed high internal consistency (Cronbach's Alpha = 0.854), with an average interitem correlation (Rho = 0.295) (Table 4). This confirms the reliability of the scale and allows to assume that there is a high correlation among items for measuring the postanesthetic recovery quality construct in a high-complexity setting.

Table 4

CQ=care quality, HU=human quality.

Patient satisfaction is an outcome measure that allows to assess 1 of the 6 quality-of-care domains, namely, "Patient-centered care."3,17 In anesthesiology, the quality of recovery is associated with the degree of patient satisfaction and quality of life; when these 2 elements are combined, they allow to obtain patient-centered results which are key for decision-making and improvement in care service provision.18

The QRS allows to include patient perspective as part of the quality indicator in recovery. When it was applied to the group of patients at HUS, it was found that 7.14% of the total sample was satisfied with the quality of recovery, as compared with the results published previously for this scale in Medellin (80.4%)." The difference in the values of the 2 publications may also be attributed to the types of procedures performed in the high-complexity hospital, and to the timing of the assessment (3 vs 24 hours).

In terms of distinction by sex, there were no statistically significant differences. In the female population, 9.3% reported satisfaction, whereas satisfaction in the male population was 5.3%. This maybe associated with the type of surgical event (short obstetric and gynecological interventions), leading to differences in the type of intervention as well as recovery.2 In this study, the percentage of dissatisfied patients was higher in all age groups.

Regional anesthesia is considered a modifier of patient satisfaction because of improved postoperative pain control and less adverse effects with the use of regional techniques.19 No statistically significant differences were found for satisfaction in relation to the anesthetic technique. In another study conducted with a visual analogue scale at San Ignacio Hospital in Bogotá, no differences were found in terms of patient satisfaction regarding the type of anesthesia. However, the results of the 2 studies are not comparable because the tools used to measure satisfaction with recovery were different.20

Satisfaction status at HUS was negatively affected by pain severity in the postoperative recovery area, and this is consistent with other studies that described an association between pain and low scores in the recovery unit.11,21,22 Like pain control, the domain for the recovery room, where items such as visits by family members, frequency of physical assessment, and the presence of the anesthetist in the PACU are rated, had a negative effect on the satisfaction score.

Finally, the high reliability level of the consistency test using Cronbach's Alpha opens the door to the application of the QRS in other institutions of higher complexity distributed in other areas of the country. This result is particularly important considering that the QRS was applied to patients who underwent surgery in 11 specialties, with satisfactory results found for orthopedics, gynecology, general surgery, gastroenterology, and urology.

Assessing satisfaction after receiving anesthesia is critical for gaining insight into patient perception regarding quality of recovery. Consistent with that objective, the QRS was applied with the aim of measuring 3 domains: overall quality, recovery room, and pain. However, in the case of Samaritana University Hospital in Bogotá, a high-complexity referral hospital, only 7.14% of the patients were satisfied with recovery, this time at 3 hours following the intervention, a shorter period of time than previously reported.

Pain is considered the fifth vital sign,23 and pain relief is considered a fundamental human right.24,25 It is expected that creating awareness about effective pain control in patients in the postoperative care area of Samaritana University Hospital will improve the satisfaction rating as quality indicator in postoperative recovery.

In addition, overall satisfaction could improve with the implementation of strategies designed to enhance care in the HUS recovery room domain. These strategies include greater frequency of wound assessment, guidance on care conditions and perioperative risk, continuous anesthetist attendance, and timely communication with family members.

A transversal descriptive study was carried out and local and international recommendations on research in humans were followed. The study was approved by the research sub-commission of the Universidad de La Sabana, through act No. 275 of November 1, 2013, and the Scientific-Ethical Committee at Hospital Universitario de La Samaritana, through act No. 4 of October 18, 2013.