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Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

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  • Additional Information
    • Contributors:
      Xu, William; Liu, Gordon; Varghese, Chri; Wells, Cameron; Smith, Nicola; Windsor, John; Gaborit, Lorane; Goh, Sarah; Basam, Aya; Elhadi, Muhammed; Soh, Rachel TingQian; Saeed, Umar; Abdulwahed, Eman; Farrell, Michael; Wright, Deborah; Martin, Jennifer; Pockney, Peter; Li, Jiting; Shah, Jainil; Waraich, Abdullah; Pathak, Upasana; Hilder, Amie; Jabur, Aiden; Kalyanasundaram, Kaviya; Ohis, Christina; Ong, Chui Foong; Park, Melissa; Siribaddana, Venesa; Raubenheimer, Kyle; Vu, Jennifer; Ferguson, Liam; Atherton, Kristy; Dawson, Amanda; Banerjee, Arnab; Dudi-Venkata, Nagendra; Lightfoot, Nichola; Ludbrook, Isabella; Peters, Luke; Sara, Rachel; Watson, David; Adeyeye, Ademola; Alvarez-Lozada, Luis Adrian; Atici, Semra Demirli; Buhavac, Milo; Calini, Giacomo; Ioannidis, Oresti; Tepe, Mustafa Deniz; Nath, Upanmanyu; Uzair, Ahmad; Yang, Wah; Zaidi, Faseeh; Singh, Surya; Abdullah, Bahiyah; Palacios, Diana Sofia Garce; Ragab, Ahmed; Ahmed, Ahmed; Daudu, Davina; Benyani, Simran Vinod; Karthikeyan, Nandini; Mansour, Laure Taher; Seow, Warren; Tasi, Zoya; Abdelmelek, Dhia Errahmane; Boussahel, Ikram Fatima Zohra; Kaabache, Oumelaz; Lemdaoui, Naoual; Nebbar, Oualid; Rais, Mounira; Abdoun, Meriem; Kouicem, Aya Tinhinane; Bouaoud, Souad; Bouchenak, Kamel; Saada, Hind; Ouyahia, Amel; Messai, Wassila; Choong, Zhi Shyuan; Ting, Clarissa; Larkin, Michelle; Fong, Pei Jun; Soh, Isabel; Grandi, Alyssia De; Iftikhar, Hareem
    • Publication Date:
      2024
    • Collection:
      IRIS Università degli Studi di Bologna (CRIS - Current Research Information System)
    • 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 (beta 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.
    • File Description:
      ELETTRONICO
    • Relation:
      info:eu-repo/semantics/altIdentifier/pmid/38207169; info:eu-repo/semantics/altIdentifier/wos/WOS:001141852800002; volume:111; issue:1; firstpage:1; lastpage:11; numberofpages:11; journal:BRITISH JOURNAL OF SURGERY; https://hdl.handle.net/11585/954164; info:eu-repo/semantics/altIdentifier/scopus/2-s2.0-85182286552; https://academic.oup.com/bjs/article/111/1/znad421/7516426
    • Accession Number:
      10.1093/bjs/znad421
    • Online Access:
      https://hdl.handle.net/11585/954164
      https://doi.org/10.1093/bjs/znad421
      https://academic.oup.com/bjs/article/111/1/znad421/7516426
    • Rights:
      info:eu-repo/semantics/openAccess
    • Accession Number:
      edsbas.8D7FECEB