Pain-related unscheduled contact with healthcare services after outpatient surgery

Abstract

This prospective, observational study explored the need for pain-related unscheduled contact with healthcare services after outpatient surgery. We hypothesised that 10% of outpatients would have pain-related unscheduled contact with healthcare services, and that the incidence would differ depending on the type of surgical procedure. In total, 905 patients who had undergone one of five common outpatient surgical procedures (knee or shoulder arthroscopy, surgical correction of hallux valgus, laparoscopic cholecystectomy or laparoscopic gynaecological procedures) completed an electronic questionnaire one week and eight weeks after surgery. Data from 732 patients (81%) were available for analysis. Within the first eight weeks after surgery, 150 patients (20.5%) had made unscheduled contact with healthcare professionals, in 247 cases due to pain that was most frequent in the first postoperative week. Risk factors were female sex, unemployment and laparoscopic cholecystectomy. The most frequent healthcare contact was with the general practitioner (46.4%), and the most frequent outcome was further information and guidance (41.2%). We have demonstrated that a minority of patients still needed to make contact with health services after outpatient surgery, most often due to inadequate pain management. This finding should be considered when planning postoperative monitoring and care, and developing postoperative patient education.

Erector Spinae Plane Block for Elective Laparoscopic Cholecystectomy in the Ambulatory Surgical Setting

“…This pain has three components: incisional pain (somatic pain from the trocar site), visceral pain, and shoulder pain (presumably referred visceral pain) [ 2 , 3 ]. Pain in general is most intense on the day of the surgery (peaking within the first 4–8 hours after surgery) and subsequently diminishes to low levels within 2–4 days [ 2 , 3 , 14 ]. The intensity of visceral pain dominates over incisional pain (especially periumbilical), which dominates over shoulder pain [ 2 ].…”

“…The average discharge time was 3.5 hours (SD 1.4), and 20% were admitted overnight most often due to pain. The clinical course of patients discharged after ambulatory laparoscopic cholecystectomy (without block) in our department has been previously described [ 14 ]. Median pain intensity was NRS 7 on the day of surgery and NRS 6, 5, 4, 1 on the 1st, 2nd, 3rd, 7th postoperative day, respectively [ 14 ].…”

“…The clinical course of patients discharged after ambulatory laparoscopic cholecystectomy (without block) in our department has been previously described [ 14 ]. Median pain intensity was NRS 7 on the day of surgery and NRS 6, 5, 4, 1 on the 1st, 2nd, 3rd, 7th postoperative day, respectively [ 14 ]. After discharge 27.9% of the patients had unscheduled pain-related contacts with healthcare services, most often in the 1st postoperative week [ 14 ].…”

“…Median pain intensity was NRS 7 on the day of surgery and NRS 6, 5, 4, 1 on the 1st, 2nd, 3rd, 7th postoperative day, respectively [ 14 ]. After discharge 27.9% of the patients had unscheduled pain-related contacts with healthcare services, most often in the 1st postoperative week [ 14 ].…”

Shared decision-making approach to taper postoperative opioids in spine surgery patients with preoperative opioid use: a randomized controlled trial

“…We chose to schedule the first follow-up at 2 weeks because it has previously been shown that more than half of unscheduled pain-related contacts occur within the first 2 weeks after surgery. 6 The postoperative questionnaires contained questions about pain intensity of back/neck and radicular pain in the past week (average NRS 0-100), consumption of opioids and other analgesics (drug name and dose [from 8 am to 8 am ], reasons for consumption [back/neck pain, radicular pain, other pain, other reason]), pain-related contacts to primary and/or secondary healthcare system (yes/no, reasons for contact [counselling/information, withdrawal symptoms, side effects, increased pain, prescription renewal, other, patients in the intervention group were instructed not to report the scheduled telephone counselling as a pain-related contact; only recorded after 2 weeks]), patient satisfaction with pain treatment (very satisfied, satisfied, neither satisfied nor dissatisfied, dissatisfied, very dissatisfied; only recorded after 2 weeks), symptoms possibly related to withdrawal (restlessness, shivering, muscle tension, leg cramps, shaking, stomachache, diarrhea, sweating, general discomfort, yes-[≥1 either symptoms], no-[0 symptoms] dichotomous outcome), and pain intensity (average NRS 0-100 back/neck and radicular pain in the past week) (Supplementary Fig. 2, supplemental digital content, available at http://links.lww.com/PAIN/B465).…”