Validation of German CARE ePROM for Postoperative Recovery in Major Urological Surgery

Overview

This study validated a German translation of the CARE questionnaire as an electronic patient-reported outcome measure (ePROM) to assess postoperative recovery after radical prostatectomy, radical cystectomy, and nephrectomy. The CARE ePROM demonstrated good psychometric properties and feasibility for capturing patient-reported health status at discharge and six weeks post-surgery.

Background

Major urological cancer surgeries such as radical prostatectomy, cystectomy, and nephrectomy require continuous evaluation of outcomes. Traditional clinician-reported measures like mortality and complications are complemented by patient-reported outcome measures (PROMs) that assess quality of life and health status. The CARE questionnaire is a validated multidimensional tool to measure postoperative convalescence, but its German version and electronic implementation had not been previously validated. Electronic PROMs facilitate outpatient monitoring and may improve postoperative care by providing timely patient feedback.

Data Highlights

The study included adult German-speaking patients undergoing major urological surgery who completed the CARE questionnaire preoperatively, at discharge, and six weeks postoperatively via an electronic system. Confirmatory factor analysis showed good model fit with Comparative Fit Index (CFI) > 0.90 and Root Mean Square Error of Approximation (RMSEA) < 0.08. The CARE questionnaire comprises 27 items across four subscales: pain, gastrointestinal, cognition, and activity, scored 0–100, with higher scores indicating better health status.

Key Findings

• The German translation of the CARE questionnaire demonstrated good psychometric validity with strong item loadings on respective subscales.
• The electronic administration of CARE was feasible and well accepted by patients, enabling remote postoperative recovery assessment.
• CARE scores effectively captured changes in patient-reported health status from baseline through discharge and six weeks post-surgery.
• Higher CARE total and subscale scores correlated with better postoperative recovery and quality of life measures.
• Factors such as age, comorbidities, sex, in-hospital complications, and BMI were considered for their influence on recovery outcomes.

Clinical Implications

The validated German CARE ePROM provides a reliable and user-friendly tool for monitoring short-term postoperative recovery in urological surgery patients. Its electronic format facilitates integration into clinical workflows and outpatient care, potentially improving symptom management and reducing complications. Routine use of CARE ePROMs can support personalized recovery tracking and timely interventions.

Conclusion

The German version of the CARE questionnaire is a valid and practical electronic PROM for assessing postoperative recovery after major urological surgeries. Its implementation can enhance patient-centered care by providing detailed insights into convalescence and health status.

References

1. Hollenbeck et al. 2008 -- Development and validation of the CARE questionnaire
2. EORTC QLQ-C30 -- Quality of life questionnaire used for comparison