Document Type
Article
Department
Obstetrics and Gynaecology; General Surgery; Orthopaedic Surgery; Urology
Abstract
Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.
Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.
Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.
Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely.
Publication (Name of Journal)
British Journal of Surgery
DOI
10.1093/bjs/znad421
Recommended Citation
Chawla, T.,
Aziz, A.,
Marium, A.,
Waheed, A. A.,
Aamir, F. B.,
Qureshi, F.,
Ather, H.,
Ali, I. M.,
Tahir, I.,
Akbar, M. G.,
Ukrani, R. D.,
Raja, S.,
Virani, S. S.,
Noordin, S.,
Rehman, S. U.,
Golani, S.,
Aamir, S. R.,
Mufarrih, S. M.,
Waqar, U.,
Taufiq, M.
(2024). Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: Multispecialty, prospective cohort study in 25 countries. British Journal of Surgery, 111(1), znad421.
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/479
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Included in
Obstetrics and Gynecology Commons, Orthopedics Commons, Surgery Commons, Urology Commons
Comments
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