To the Editor:

The study by Royse et al.  1on the postoperative quality recovery score is interesting because it attempts to address the patient's perspective in some manner. Researchers have not paid much attention to the patient's opinion in the development of postoperative assessment tools. This may be important because, for instance, after laparoscopic cholecystectomy, most patients believed that they were not ready for discharge while nursing staff had the opposite view.2In a prospective study3of 194 outpatients, when patients determined their own discharge readiness, the time they felt discharge ready was significantly shorter than the actual time they were discharged based on nursing assessments. In light of these findings, we suggest that perhaps the patients' input should be considered with a view to improving the relevance of the postoperative quality recovery score. We believe that the patient's opinion is crucial and deserves a greater weighting in the “physiology domain” of the postoperative quality recovery score. In addition, we question the relevance of items that assess functional recovery from actual surgery as being too simplistic. The surgical literature has more sophisticated tools that are surgery specific (e.g. , the Constance score for shoulder surgery).4Perhaps consideration should be given to underweighting items that pertain to functional recovery from surgery.

*University of British Columbia, Vancouver, British Columbia, Canada.


Royse CF, Newman S, Chung F, Stygall J, McKay R, Boldt J, Servin F, Hurtado I, Hannallah R, Yu B, Wilkinson D: Development and feasibility of a scale to assess postoperative recovery. Anesthesiology 2010; 113:892–905
Fleisher LA, Yee K, Lillemoe KD, Talamini MA, Yeo CJ, Heath R, Bass E, Snyder DS, Parker SD: Is outpatient laparoscopic cholecystectomy safe and cost-effective? A model to study transition of care. Anesthesiology 1999; 90:1746–55
Vaghadia H, Cheung K, Henderson C, Stewart AVG, Lennox PH: A quantification of discharge readiness after outpatient anesthesia: Patients' versus  nurses' assessment. S Afr J Anesth Analg 2003; 9:5–9
Constant CR, Murley AH: A clinical method of functional assessment of the shoulder. Clin Orthop 1987; 214:160–4