External Validation and Modification of a Predictive Model for Acute Postsurgical Pain at Home After Day Surgery

Stessel, Björn; Fiddelers, Audrey A. A.; Marcus, Marco A. E.; Kuijk, Sander M J van; Joosten, Elbert A.J.; Peters, Madelon L.; Buhre, W.; Gramke, Hans-Fritz

doi:10.1097/ajp.0000000000000413

Cited by 15 publications

(12 citation statements)

References 34 publications

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“…The positive correlation between postoperative pain and poor QOR has already been suggested in a previous study. A large prospective cohort study found that patient derived expected pain, which is a good predictor of high postoperative pain levels [ 28 ], is also a predictor of poor QOR at POD 4 [ 18 ]. This makes sense as postoperative pain plays a pivotal role in the QOR after surgery and is also known to be closely related with not only the physical status but also socio-cultural, cognitive, psychological and functional dimensions [ 1 ].…”

Section: Discussionmentioning

confidence: 99%

One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial

et al. 2021

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Background/Objectives This study aimed to study one-month recovery profile and to identify predictors of Quality of Recovery (QOR) after painful day surgery and investigate the influence of pain therapy on QOR. Methods/Design This is a secondary analysis of a single-centre, randomised controlled trial of 200 patients undergoing ambulatory haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair between January 2016 and March 2017. Primary endpoints were one-month recovery profile and prevalence of poor/good QOR measured by the Functional Recovery Index (FRI), the Global Surgical Recovery index and the EuroQol questionnaire at postoperative day (POD) 1 to 4, 7, 14 and 28. Multiple logistic regression analysis was performed to determine predictors of QOR at POD 7, 14, and 28. Differences in QOR between pain treatment groups were analysed using the Mann-Whitney U test. Results Four weeks after haemorrhoid surgery, inguinal hernia repair, arthroscopic knee and arthroscopic shoulder surgery, good QOR was present in 71%, 76%, 57% and 24% respectively. Poor QOR was present in 5%, 0%, 7% and 29%, respectively. At POD 7 and POD 28, predictors for poor/intermediate QOR were type of surgery and a high postoperative pain level at POD 4. Male gender was another predictor at POD 7. Female gender and having a paid job were also predictors at POD 28. Type of surgery and long term fear of surgery were predictors at POD 14. No significant differences in total FRI scores were found between the two different pain treatment groups. Conclusions The present study shows a procedure-specific variation in recovery profile in the 4-week period after painful day surgery. The best predictors for short-term (POD 7) and long-term (POD 28) poor/intermediate QOR were a high postoperative pain level at POD 4 and type of surgery. Different pain treatment regimens did not result in differences in recovery profile. Trial registration European Union Clinical Trials Register 2015-003987-35.

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Section: Discussionmentioning

confidence: 99%

One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial

et al. 2021

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“…Predictive models have been developed to forecast high levels of acute postoperative pain, incorporating questionnaires such as those listed above [49]. Clinical tools to assess preoperative psychological state may not be commonplace in routine practice.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders

Doan

Blitz

2020

Curr Anesthesiol Rep

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Purpose of Review This review summarizes selected recent evidence on issues important for preoperative pain evaluation. Recent Findings Opioids, though a mainstay of postoperative pain management, are associated with both short and increasingly recognized long-term risks, including persistent opioid use. Risk factors for high levels of acute postoperative pain as well as chronic postsurgical pain may overlap, including psychological factors such as depression, anxiety, and catastrophizing. Tools to predict those at risk for poor postoperative pain outcomes are being studied.

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“…Although painful surgeries can be performed in an ambulatory setting, the postoperative analgesia after day surgery can become an enormous challenge for patients. Unlike hospital stay which provides the patients specialized personnel, different types of analgesics, and various routes of administration (2,3), home care can have a lot of limitations in terms of the mentioned factors (4). This can explain the high prevalence of acute pain in the first 24 -48 hours after acute day surgery, despite the increased awareness and introduction of multimodal pain therapy strategies over the last decades (5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery

et al. 2020

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Background: Nowadays, complicated and painful surgical procedures are encouraged to be carried out in an ambulatory setting. Objectives: The current study aimed to assess 4-week postoperative pain profiles of 4 painful ambulatory surgical procedures. We analyzed the prevalence of and reasons for non-adherence and partial adherence of patients to a predefined treatment schedule after the ambulant surgery. Methods: The current study analyzed data from a large randomized trial by evaluating the effect of postoperative pain medication on acute postoperative pain at home during the first 4 postoperative days (POD) in patients scheduled for ambulatory hemorrhoid surgery, shoulder or knee arthroscopy, and inguinal hernia repair. Postoperative pain intensity was assessed at POD 0, 1, 2, 3, 4, 7, 14, and 28 via the Numeric Rating Scale (NRS). Adherence was assessed on POD 1, 2, 3, and 4. Results: Median average pain scores were above an NRS of 3 during the first postoperative week after shoulder arthroscopy and even above 4 during the first postoperative week after hemorrhoid surgery. 26% of patients undergoing shoulder arthroscopy and hemorrhoid surgery still had moderate pain 1 week after surgery. Median average pain scores were below an NRS of 3 during the whole study period after inguinal hernia repair and knee arthroscopy. 24.61% of patients did not use the study medication as prescribed, 5.76% of whom were non-adherent, and 18.85% were partially adherent. Conclusions: Each type of ambulant surgery has its unique postoperative pain profile. New strategies should be developed for pain therapy at home, particularly after the ambulatory arthroscopic shoulder surgery and hemorrhoid surgery. Non-adherence is uncommon if they are provided with a multimodal analgesic home kit together with clear verbal, written instructions, and intensive follow-up.

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External Validation and Modification of a Predictive Model for Acute Postsurgical Pain at Home After Day Surgery

Cited by 15 publications

References 34 publications

One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial

One-month recovery profile and prevalence and predictors of quality of recovery after painful day case surgery: Secondary analysis of a randomized controlled trial

Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders

Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery

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