Challenges in Anaesthetic PROMs Data Collection (Preprint)
Authors: Brown Alex , Dunstan Claire , Huckle Danielle 
Published: February 2025

UNSTRUCTURED

Introduction
Patient-Reported Outcome Measures (PROMs) are essential in anaesthesia practice, supporting patient-centered care. Digitizing PROMs offers benefits like improved data management and response rates, but its implementation in Wales remains underexplored. This feasibility study aims to develop a validated digital framework for collecting PROMs data specific to peri-operative anaesthesia care at Cardiff and Vale University Health Board (CAVUHB), enabling the identification of areas for improvement and continuous evaluation of changes.

Methods
Validated questionnaires were selected: the EQ-5D-5L and EQ-5D Visual Analogue Scale (VAS) to assess Health-Related Quality of Life, and the Bauer questionnaire for patient satisfaction specific to anaesthesia. These were digitized using the My Clinical Outcomes (MCO) system. Patients undergoing elective colorectal surgery completed the questionnaires preoperatively, 5 days postoperatively, and 3 months post-surgery, with automated reminders for overdue assessments.

Results
From November 2023 to October 2024, 121 patients registered with MCO. Of these, 107 completed the pre-operative questionnaires, 71 completed the 5-day post-operative assessments, and 49 were followed up at 3 months. The average EQ-5D-5L scores for the three time points were 83.9 (pre-op), 73.6 (5-day post-op), and 83.9 (3 months), while the VAS scores were 73.7, 63.1, and 74.5, respectively. These results reflected the expected decline in performance status following surgery, followed by a return to or improvement at 3 months. Within the EQ-5D-5L, the domains most affected were ‘Pain/Discomfort’ and ‘Usual Activities’
The Bauer questionnaire revealed that 49% of patients experienced moderate or severe pain at the surgical site. Other common side effects included drowsiness and thirst. 18% of patients reported severe nausea
Further analysis of patients reporting severe postoperative pain (14%) showed a significant correlation (P = 0.004) with higher pre-operative anxiety/depression scores. Interestingly, no significant association was found between pre-operative pain scores and postoperative pain.
Length of surgical procedure appeared to influence postoperative nausea. Patients who reported severe nausea had an average operation time of 204 minutes, compared to 142 minutes for those without severe nausea (P = 0.13)

Discussion
The project faced challenges with scoring systems, system limitations, data collection issues, patient education, and language barriers. Scoring for the EQ-5D-5L was adjusted to align with the numerical EQ-5D VAS scale, enhancing data analysis. System limitations, such as patient self-registration and lack of integration with existing electronic systems, were addressed by revising the MCO platform to send individualized links and automate patient data input. Additionally, multilingual options were introduced to address language barriers
Conclusion
This feasibility study demonstrates that digital PROMs collection is a valuable tool for perioperative care providing a streamlined approach to data analysis. Key recommendations for successful adoption include the importance of a digital platform, system integration, patient education, and multilingual support. Future work will focus on expanding PROMs collection across surgical specialties and integrating additional patient data to optimize perioperative care