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 - Seow, Warren
AU - Tasi, Zoya
AU - Park, Melissa
AU - Abdelmelek, Dhia Errahmane
AU - Boussahel, Ikram Fatima Zohra
AU - Kaabache, Oumelaz
AU - Lemdaoui, Naoual
AU - Nebbar, Oualid
AU - Rais, Mounira
AU - Abdoun, Meriem
AU - Kouicem, Aya Tinhinane
AU - Bouaoud, Souad
AU - Bouchenak, Kamel
AU - Saada, Hind
AU - Ouyahia, Amel
AU - Messai, Wassila
AU - Choong, Zhi Shyuan
AU - Ting, Clarissa
AU - Larkin, Michelle
AU - Fong, Pei Jun
AU - Soh, Isabel
AU - De Grandi, Alyssia
AU - Iftikhar, Hareem
AU - Sinha, Akansha
AU - Kapoor, Dhruv
AU - Chlebicka, Tara
AU - Singer, David
AU - Goddard, Kim
AU - Matthews, Lisa
AU - Lin, Rosalina
AU - Chambers, Jessica
AU - Chan, Juliet
AU - Macnab, Brooke
AU - Barker, John
AU - McKenzie, Morgan
AU - Ferguson, Neil
AU - Juwaheer, Ghanisht
AU - Walters, Chris
AU - Nguyen, Kevin
AU - Liu, David
AU - Cabalag, Carlos
AU - Lee, Jennifer
AU - Leow, San Hui Anita
AU - Ng, Suat Li
AU - Ashraf, Hamza
AU - Mulder, Fraizer
AU - Loo, Jonathan
AU - Proud, David
AU - Wong, Samantha
AU - Zhou, Yida
AU - Soh, Qi Rui
AU - Chye, David
AU - Stevens, Sean
AU - Tang, Patrick
AU - Kritharides, Stephen
AU - Dong, Jason
AU - Morice, Oscar
AU - Huang, Dora
AU - Hardidge, Andrew
AU - Amarasekara, Mishka
AU - Kink, Aleah
AU - Bolton, Damien
AU - Rawal, Alisha
AU - Singh, Jasraaj
AU - Heard, Matthew
AU - Hassan, Yusuf
AU - Naqeeb, Ahmed
AU - Cobden, Andrew
AU - Prinsloo, Duron
AU - Quadros, Dwain
AU - Gunn, Emma
AU - Kim, Ha Jin
AU - Ekwebelam, Jennifer
AU - Shanahan, James
AU - Alkazali, Mustafa
AU - Hoosenally, Mariyah
AU - Nara, Naveen
AU - Nguyen, Peter
AU - Barker, Sally
AU - Tamsett, Zacchary
AU - Rigby, Naomi
AU - Patel, Hinal
AU - Ferguson, Eloise
AU - Byrnes, Lauren
AU - Bravo, Alexander
AU - Hui, Ally
AU - Karmakar, Antara
AU - Wang, Bill
AU - Goonawardena, Janindu
AU - Cheung, King Tung
AU - Chan, Nicholas
AU - Natarajan, Ragul
AU - Cade, Richard
AU - Jin, Rong
AU - Sengupta, Shomik
AU - Snider, Ruth
AU - Morisetty, Harsha
AU - Weeda, Lewis
AU - Sun, Phoebe
AU - Chilaka, Lalitya
AU - Cover, Jacinta
AU - De Silva Abeweera Gunasekara, Aashrinee
AU - Senthilrajan, Rahavi
AU - Alwahaib, Anas
AU - Limmer, Alexandra
AU - Zamanbandhon, Bushra
AU - Jaffry, Kumail
AU - Shen, Yijia
AU - Chua, Alan
AU - Syed, Saifulla
AU - Saha, Sushanth
AU - Glynatsis, John
AU - Aitchison, Lori
AU - Lagana, Bernard
AU - Crossman, Mason
AU - Dawson, Abby
AU - Fong, Bryan
AU - Harrison, Ella
AU - Horsburgh, Eleanor
AU - Khoo, Michael
AU - Mishra, Kritika
AU - Hewton, Lewis
AU - Mesecke, Alex
AU - Tu, Hien
AU - Tun, Than
AU - Wong, Jason
AU - Ong, Elynn
AU - Law, Tara Nyssa
AU - Landy, Ashlee
AU - Leano, Alyssa
AU - Li, Andrea
AU - Soni, Akshay
AU - Dowdle, Benjamin
AU - Pilgrim, Charles
AU - Abeysirigunawardana, Dewmi
AU - Jeyarajan, Deepak Rajan
AU - Patel, Diya
AU - McKinnon, Kyle
AU - Gould, Madeline
AU - Gilmore, Paul
AU - Geng, Ruxi
AU - Loughnan, Rachael
AU - Norton-Smith, Sarahjane
AU - Nyame, Solomon
AU - Tan, Sarah
AU - Yoon, Si Woo
AU - Wang, Yantong
AU - Zhang, Yichi
AU - Wang, Zixuan
AU - Mare, Hans
AU - Withanage, Indrajith
AU - Khattar, Mitali
AU - Toft, Alexandra
AU - Sivasuthan, Goutham
AU - Zhao, Hailin
AU - Addley, Jordan
AU - O'Brien, Lucinda
AU - Raza, Muhammad
AU - Bindra, Randipsingh
AU - Sharma, Sonakshi
AU - Cornwell, Charlotte
AU - Patil, Aditya
AU - Cheung, Aiden
AU - Lown, Ashleigh
AU - Blassey, Aneel
AU - Ochigbo, Benjamin
AU - Cheng, Felicity
AU - Fatima, Aleeza
AU - Zhang, Edward
AU - Kocatekin, Henry
AU - Roth, Charles
AU - Brewster, Dani
AU - Kwok, Kelvin
AU - Chen, Paul
AU - Laura, Sharon
AU - Tynan, Dominic
AU - Latif, Edward
AU - Lun, Elizabeth
AU - Honore, Elodie
AU - Ziergiebel, Felix
AU - Blake, Jessica
AU - Chandiok, Karan
AU - Bird, Katie
AU - Ngothanh, Lynette
AU - Lee, Melissa
AU - El-Masry, Mariam
AU - Hamer, Peter
AU - Palaniappan, Ramanathan Rm
AU - McGee, Richard
AU - Huang, Sarah
AU - Zhang, Shane
AU - Hariharan, Shubhang
AU - De Silva, Yannick
AU - Lee, Celeste
AU - Fotheringham, Penelope
AU - Evans, Natalie
AU - Robinson, Samuel
AU - Neo, Eu Ling
AU - Anderson, Paul
AU - Nguyen, Kim
AU - Stewart, Peter
AU - Wong, Patrick
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.
KW - Orthopaedics
KW - Education
KW - Urology
KW - General Surgery
KW - Acute Care Surgery
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 -