Background: In this systematic review we aimed to appraise the evidence relating to the measurement properties of unidimensional tools to quantify pain after surgery. Furthermore, we wished to identify the tools used to assess interference of pain with functional recovery. Methods: Four electronic sources (MEDLINE, Embase, CINAHL, PsycINFO) were searched in August 2020. Two reviewers independently screened articles and assessed risk of bias using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. Results: Thirty-one studies with a total of 12 498 participants were included. Most of the studies failed to meet the methodological quality standards required by COSMIN. Studies of unidimensional assessment tools were underpinned by low-quality evidence for reliability (five studies), and responsiveness (seven studies). Convergent validity was the most studied property (13 studies) with moderate to high correlation ranging from 0.5 to 0.9 between unidimensional tools. Interpretability results were available only for the visual analogue scale (seven studies) and numerical rating scale (four studies). Studies on functional assessment tools were scarce in which only one study included an 'Objective Pain Score;' a tool assessing pain interference with respiratory function and had low-quality for convergent validity. Conclusions: This systematic review challenges the validity and reliability of unidimensional tools in patients after surgery. We found no evidence that any one unidimensional tool has superior measurement properties in assessing postoperative pain. In addition, because promoting function is a crucial perioperative goal, psychometric validation studies of functional pain assessment tools are needed to improve pain assessment and management. Clinical trial registration: PROSPERO CRD42020213495.
Summary This retrospective cohort study on adults undergoing colectomy from 2010 to 2019 used linked primary (Clinical Practice Research Datalink), and secondary (Hospital Episode Statistics) care data to determine the prevalence of persistent postoperative opioid use following colectomy, stratified by pre‐admission opioid exposure, and identify associated predictors. Based on pre‐admission opioid exposure, patients were categorised as opioid‐naïve, currently exposed (opioid prescription 0–6 months before admission) and previously exposed (opioid prescription within 7–12 months before admission). Persistent postoperative opioid use was defined as requiring an opioid prescription within 90 days of discharge, along with one or more opioid prescriptions 91–180 days after hospital discharge. Multivariable logistic regression analyses were conducted to obtain odds ratios for predictors of persistent postoperative opioid use. Among the 93,262 patients, 15,081 (16.2%) were issued at least one opioid prescription within 90 days of discharge. Of these, 6791 (45.0%) were opioid‐naïve, 7528 (49.9%) were currently exposed and 762 (5.0%) were previously exposed. From the whole cohort, 7540 (8.1%) developed persistent postoperative opioid use. Patients with pre‐operative opioid exposure had the highest persistent use: 5317 (40.4%) from the currently exposed group; 305 (9.8%) from the previously exposed group; and 1918 (2.5%) from the opioid‐naïve group. The odds of developing persistent opioid use were higher among individuals who used long‐acting opioid formulations in the 180 days before colectomy than those who used short‐acting formulations (odds ratio 3.41 (95%CI 3.07–3.77)). Predictors of persistent opioid use included: previous opioid exposure; high deprivation index; multiple comorbidities; use of long‐acting opioids; white race; and open surgery. Minimally invasive surgical approaches were associated with lower odds of persistent opioid use and may represent a modifiable risk factor.
Introduction Opioid prescribing patterns after discharge following colectomy within a population from England are not well characterised. This study aimed to report changes in opioid prescribing prevalence, formulation choices and opioid analgesics over time. Methods This cross-sectional analysis included people undergoing colectomy between 2010 and 2019 using primary (Clinical Practice Research Datalink) and linked secondary care (Hospital Episode Statistics) data. The prevalence of initial opioid prescription within 90 days of surgical discharge was calculated, and prescription characteristics in terms of analgesics and formulation were described. Trend analysis was performed using the Cochran Armitage test, and percentage change between 2010 and 2019 was tested using univariate logistic regression. Results Of the 95,155 individuals undergoing colectomy within the study period, 15,503 (16.3%) received opioid prescriptions. There was a decreasing trend in the prevalence of post-discharge opioids for opioid naïve people (P<0.001), with a decrease from 11.4% in 2010 to 6.7% in 2019 (-41.3%, p<0.001). Whereas the prevalence remained stable for patients prescribed opioids prior to surgery (p=0.637). The prescribing of immediate release formulations decreased from 86% in 2010 to 82% in 2019 (-4.65%). Codeine represented 44.5% of all prescriptions and prescribing increased by 14.5% between 2010 and 2019. Moreover, morphine and oxycodone prescriptions rose significantly by 76.6% and 131%, respectively, while tramadol prescribing dropped by 48%. Conclusion This study identified a changing pattern of opioid prescribing following colectomy, with prescribing prevalence decreasing for opioid naïve people. Trends suggested decreased tramadol prescribing, but a shift toward increasing codeine, oxycodone and morphine prescriptions.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.