TY - JOUR
T1 - Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery
T2 - multispecialty, prospective cohort study in 25 countries
AU - TASMAN Collaborative
AU - Xu, William
AU - Smith, Nicolas
AU - Ting, Rachel
AU - Soh, Qian
AU - Saeed, Umar
AU - Farrell, Michael
AU - Wright, Deborah
AU - Li, Jiting
AU - Waraich, Abdullah
AU - Gaborit, Lorane
AU - Jabur, Aiden
AU - Kalyanasundaram, Kaviya
AU - Ohis, Christina
AU - Foong, Chui
AU - Ong,
AU - Siribaddana, Venesa
AU - Raubenheimer, Kyle
AU - Vu, Jennifer
AU - Ferguson, Liam
AU - Varghese, Chris
AU - Pockney, Peter
AU - Atherton, Kristy
AU - Martin, Jennifer
AU - Banerjee, Arnab
AU - Dudi-Venkata, Nagendra
AU - Lightfoot, Nicholas
AU - Ludbrook, Isabella
AU - Peters, Luke
AU - Sara, Rachel
AU - Watson, David
AU - Adeyeye, Ademola
AU - Alvarez-Lozada, Luis Adrian
AU - Atici, Semra Demirli
AU - Buhavac, Milos
AU - Calini, Giacomo
AU - Elhadi, Muhammed
AU - Ioannidis, Orestis
AU - Tepe, Mustafa Deniz
AU - Nath, Upanmanyu
AU - Uzair, Ahmad
AU - Yang, Wah
AU - Zaidi, Faseeh
AU - Abdullah, Bahiyah
AU - Ragab, Ahmed
AU - Daudu, Davina
AU - Benyani, Simran Vinod
AU - Karthikeyan, Nandini
AU - Mansour, Laure Taher
AU - Chawla, Tabish
AU - Noordin, Shahryar
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - 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 sideeffects 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 lowand 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.
AB - 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 sideeffects 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 lowand 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.
UR - http://www.scopus.com/inward/record.url?scp=85182676823&partnerID=8YFLogxK
U2 - 10.1093/bjs/znad421
DO - 10.1093/bjs/znad421
M3 - Article
C2 - 38207169
AN - SCOPUS:85182676823
SN - 0007-1323
VL - 111
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 1
M1 - znad421
ER -