Post-discharge Pain Research Articles

Paediatric laceration repair in the emergency department: post-discharge pain and maladaptive behavioural changes

BackgroundPaediatric laceration repair procedures are common in the ED; however, post-discharge recovery remains understudied. Perioperative research demonstrates that children exhibit maladaptive behavioural changes following stressful and painful medical procedures. This...

Patient Preferences for Operative Versus Nonoperative Treatment of LC1 Pelvis Fracture: A Discrete Choice Experiment.

To quantify how patients with lateral compression type 1 (LC1) pelvis fracture value attributes of operative versus nonoperative treatment. Discrete choice experiment. Three US Level 1 trauma centers. Adult survivors of an LC1 pelvis treated between June 2016 and March 2023 were identified from institutional registries. The choice experiment was administered as a survey from March through August 2023. Participants chose between 12 hypothetical comparisons of treatment attributes including operative or nonoperative care, risk of death, severity of pain, risk of secondary surgery, shorter hospital stay, discharge destination, and independence in ambulation within 1 month of injury. The marginal utility of each treatment attribute, for example, the strength of participants' aggregate preference for an attribute as indicated by their survey choices, was estimated by multinomial logit modeling with and without stratification by treatment received. Four hundred forty-nine eligible patients were identified. The survey was distributed to 182 patients and collected from 72 patients (39%) at a median 2.3 years after injury. Respondents were 66% female with a median age of 59 years (IQR, 34-69 years). Before injury, 94% ambulated independently and 75% were working; 41% received operative treatment. Independence with ambulation provided the highest relative marginal utility (21%, P < 0.001), followed by discharge to home versus skilled nursing (20%, P < 0.001), moderate versus severe postdischarge pain (17%, P < 0.001), shorter hospital stay (16%, P < 0.001), secondary surgery (15%, P < 0.001), and mortality (10%, P = 0.02). Overall, no relative utility for operative versus nonoperative treatment was observed (2%, P = 0.54). However, respondents strongly preferred the treatment they received: operative patients valued operative treatment (utility, 0.37 vs. -0.37, P < 0.001); nonoperative patients valued nonoperative treatment (utility, 0.19 vs. -0.19, P < 0.001). LC1 pelvis fracture patients valued independence with ambulation, shorter hospital stay, and avoiding secondary surgery and mortality in the month after their injury. Patients preferred the treatment they received rather than operative versus nonoperative care.

The long-term intercorrelation between post-burn pain, anxiety, and depression: a post hoc analysis of the “RE-ENERGIZE” double-blind, randomized, multicenter placebo-controlled trial

BackgroundDespite the growing prevalence of burn survivors, a gap persists in our understanding of the correlation between acute burn trauma and the long-term impact on psychosocial health. This study set out to investigate the prevalence of long-term pain and symptoms of anxiety and depression in survivors of extensive burns, comparing this to the general population, and identify injury and demographic-related factors predisposing individuals to psychosocial compromise.MethodsRE-ENERGIZE was an international, double-blinded, randomized-controlled trial that enrolled 1200 patients with partial- or full-thickness burns that required surgical treatment. For the post hoc analysis, we excluded participants who did not complete the Short Form Health Survey (SF-36) questionnaire. Normative data were taken from the 2021 National Health Interview Survey dataset. Propensity score matching was performed using the nearest-neighbor 1-to-1 method, and the two cohorts were compared in terms of chronic pain, and symptoms of anxiety and depression. A multivariable analysis was performed on the burns cohort to identify factors predicting post-discharge pain and symptoms of anxiety and depression.ResultsA total of 600 burn patients and 26,666 general population adults were included in this study. Following propensity score matching, both groups comprised 478 participants each, who were predominately male, white, overweight and between 20 and 60 years old. Compared to the general population, burn patients were significantly more likely to report the presence of moderate and a lot of pain (p = 0.002). Symptoms of anxiety were significantly higher in the burn population in two of four levels (most of the time; some of the time; p < 0.0001 for both). Responders in the burn population were significantly less likely to report the absence of depressive symptoms (p < 0.0001). Burn patients were also significantly more likely to report that their mental health affects their social life. TBSA, history of depression, and female sex were identified as independently associated factors for pain, anxiety, and depressive symptoms. The presence of chronic pain and anxiety symptoms independently predicted for symptoms of depression.ConclusionsAnalyzing the largest multicenter cohort of patients with extensive burns, we find that burn injury is associated with chronic pain, and symptoms of anxiety and depression. In addition, TBSA-burned and history of depression directly correlate with the prevalence of chronic pain, and symptoms of anxiety and depression. Finally, pain, and symptoms of anxiety and depression are interrelated and may have interactive effects on the process of recovery following burn injury. Burn patients would, therefore, benefit from a multidisciplinary team approach with early mobilization of pain and mental health experts, in order to promptly prevent the development of psychosocial challenges and their consequences.

1304 Feasibility of Day-Case Laparoscopic Cholecystectomy in Paediatric Patients

Abstract Aim Standard approach for treatment of cholecystolithiasis is laparoscopic cholecystectomy (LC), however day-case laparoscopic cholecystectomy (DCLC) has not been established as standard procedure in paediatric population. This is to assess the feasibility and safety of DCLC in paediatric population focusing on post-operative outcomes as a measure of success and using a protocolised post-operative pain management approach. Method Data, which include demographics, surgeon (trainee/consultant), admission mode, length of stay, complications, and post-operative pain management as per hospital protocol were collected from the hospital database from 2016 to 2022. Patients who underwent DCLS were discharged within 23 hours. Telephone survey was conducted to investigate type and length of analgesia administered at home. Results 31 patients underwent LC with a day-case rate of 77%. 63% were female. Mean age was 11 years (3 - 16). Obesity and haemolytic disorders were present in 29% and 8%, respectively. 96% were elective admissions. 20% had ASA I, 48% ASA II and 32% ASA III. Post-operatively, opioids with paracetamol/ibuprofen were administered in 96%, and in 80% as post-discharge analgesia. Post-discharge analgesia was administered 1 - 7 days, and 28% used oral opioid analgesia at home up to 3 days. Post-operative complications were present in 2 patients - 1 infected umbilical wound and 1 persistent dyspepsia. Six months readmission rate was 8% due to hypogastric pain treated conservatively. After a 3-month follow-up, all the patients were discharged. Conclusions LC can be performed safely as a day case procedure with excellent outcomes using a standardised post-operative and post-discharge pain management protocol.

Predictors of post-discharge pain and satisfaction with pain management after laparoscopic bariatric surgery: a prospective cohort study.

Pain management after bariatric surgery remains challenging given the risk for analgesia-related adverse events (e.g., opioid use disorder, marginal ulcers). Identifying modifiable factors associated with patient-reported pain outcomes may improve quality of care. We evaluated the extent to which patient and procedural factors predict 7-day post-discharge pain intensity, pain interference, and satisfaction with pain management after bariatric surgery. This prospective cohort study included adults undergoing laparoscopic bariatric surgery at two university-affiliated hospitals and one private clinic. Preoperative assessments included demographics, Pain Catastrophizing Scale (score range 0-52), Patient Activation Measure (low [< 55.1] vs. high [≥ 55.1]), pain expectation (0-10), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) anxiety and depression scales. At 7days post-discharge, assessments included PROMIS-29 pain intensity (0-10) and pain interference scales (41.6-75.6), and satisfaction with pain management (high [10-9] vs. lower [8-0]). Linear and logistic regression were used to assess the association of pain outcomes with potential predictors. Three hundred and fifty-one patients were included (mean age = 44 ± 11years, BMI = 45 ± 8kg/m2, 77% female, 71% sleeve gastrectomy). At 7days post-discharge, median (IQR) patient-reported pain intensity was 2.5 (1-5), pain interference was 55.6 (52.0-61.2), and 76% of patients reported high satisfaction with pain management. Pain intensity was predicted by preoperative anxiety (β + 0.04 [95% CI + 0.01 to + 0.07]) and pain expectation (+ 0.15 [+ 0.05 to + 0.25]). Pain interference was predicted by preoperative anxiety (+ 0.22 [+ 0.11 to + 0.33]), pain expectation (+ 0.47 [+ 0.10 to + 0.84]), and age (- 0.09 [- 0.174 to - 0.003]). Lower satisfaction was predicted by low patient activation (OR 1.94 [1.05-3.58]), higher pain catastrophizing (1.03 [1.003-1.05]), 30-day complications (3.27 [1.14-9.38]), and age (0.97 [0.948-0.998]). Patient-related factors are important predictors of post-discharge pain outcomes after bariatric surgery. Our findings highlight the value of addressing educational, psychological, and coping strategies to improve postoperative pain outcomes.

Postdischarge pain, fatigue severity and quality of life in COVID-19 survivors

Objectives: Fatigue and pain symptoms were common complaints among post-COVID-19 patients, and these lead to impaired quality of life (QoL). We aimed to evaluate severity of pain and fatigue 3 months after disease onset in discharged COVID-19 patients. Methods: Patients were contacted by phone at their third month following disease onset. Demographic data of the patients such as weight, height, body mass index (BMI), gender, smoking history, comorbidities, length of hospitalization, duration of stay in the intensive care unit, were recorded. The patients' pain and fatigue severities were evaluated by visual analog scale (VAS). QoL was questioned with the EuroQol Group Association five-domain, three-level questionnaire (EQ-5D-3L). Results: A total of 392 participants enrolled into the study. At admission, 94.6% of the participants had fatigue and 73.7% of them had pain. A high proportion of them still reported fatigue (55.1%) and pain (41.3%) at third month. The mean value of pain-VAS score was 5.37 ± 3.85, and it was 7.58 ± 2.82 for fatigue-VAS at admission. VAS scores of pain and fatigue at third month were 1.44 ± 2.11 and 2.04 ± 2.40 respectively. While 66.6% of the patients reported moderate-severe pain at disease onset, the rate was 18.1% at the third month. And also almost half had severe pain at admission (48%), it was 2.8% at third month. At disease onset 89.6% of the patients reported moderate-severe fatigue (severe: 48%). Aproximately one third of them had moderate-severe fatigue (27.9%) at third month (severe: 5.1%). The mean value of EQ-VAS score was 26.76 ± 20.26 at admission, and it was 78.84 ±16.15 at third month. Statistically significant differences were recorded between the disease onset and third month in terms of pain-VAS fatigue-VAS, and EQ-VAS scores (p &amp;lt; 0.001). Female gender, ICU admission, long duration of hospitalization, older age, higher BMI scores, multiple comorbidities, fatigue and pain severity were related to the decrease in QoL scores. Conclusions: Hospitalized COVID-19 survivors need ongoing support for pain, fatigue complaints and impaired QoL after discharge. The factors that cause poor QoL should be taken into account during post-COVID-19 follow up.

Efficacy and safety of 5% lidocaine patches for postoperative pain management in patients undergoing unilateral inguinal hernia repair: study protocol for a prospective, double-blind, randomized, controlled clinical trial

BackgroundAcute postoperative pain is a common complication of inguinal hernia repair. Pain management using local application of anesthetic agents over the skin surrounding the surgical incision may reduce the requirement for other pain medications. Targeted topical analgesics such as 5% lidocaine patches have been known to improve acute and chronic pain. However, the clinical effect of lidocaine patches on postoperative pain after inguinal hernia repair has not been studied, especially in patients undergoing surgery at day surgery units.Methods/designThis is a single-center, prospective, double-blind, randomized, controlled clinical trial. Participants with unilateral inguinal hernia will be randomized to the lidocaine patch group or the placebo patch group. Based on the randomized allocation sequence, either lidocaine patches or placebo patches will be attached near each participant’s surgical wound after open hernia repair under general anesthesia. Participants will be asked to follow up at our outpatient clinic on the first postoperative day and at 1 week after surgery. The primary outcome is pain intensity, which will be measured using the visual analog scale (VAS) at the time of discharge from the day surgery unit. The secondary outcomes are VAS score at 24 h and 1 week after surgery. We will collect and analyze the participants’ clinical data (amount of intraoperative opioid use, time to recovery, and pain intensity at 30 min after surgery) and demographic characteristics (age, sex, body weight, and height).DiscussionThis trial may not only provide evidence on the efficacy of a 5% lidocaine patch for acute postoperative pain management after unilateral inguinal hernia repair, but also demonstrate the efficacy and safety of the patch for post-discharge pain management.Trial registrationClinicalTrials.gov NCT04754451. Registered on February 10, 2021.

Association of request for opioid medications refill after hospital discharge with race in patients with prostate cancer treated with robotic-assisted laparoscopic radical prostatectomy.

Request for refills of opioids is one of the indicators of possible misuse. We aimed to investigate racial variations in request for refills of opioids after hospital discharge from robotic-assisted laparoscopic radical prostatectomy (RALP). We conducted a retrospective study of a contemporary cohort of patients treated with RALP for prostate cancer and post-operative standardized pain control that employed nonopioid medications. Patients' request for refills of opioids (within 30 days) after discharge was examined, accounting for race, age, pain control after surgery, alcohol intake, marijuana consumption, pre-existing behavioral health diagnoses, and pre-existing chronic pain disorders using multivariate analysis. p-Value of < 0.05 was considered significant. We included a total of 282 adult patients in this study. African Americans (AA) patients comprised 24.5 percent of our post-prostatectomy individuals. Of the total cohort, 94.3 percent of patients reported adequate pain control in the hospital after surgery, and only 5.7 percent requested refills of opioid medications after discharge. No racial variations in request of refills were identified. Only pre-existing chronic pain disorders were found to be a significant predictor of requesting an opioid medication refill for pain control after discharge from the hospital. A combination of minimally invasive surgery and nonopioid heavy pain management leads to low level of post-hospital discharge request for refills of opioid medication in patients treated with RALP across racial groups. Awareness and better control of chronic pain perioperatively are needed to ensure better postdischarge pain control.

Preoperative Education for Less Outpatient Pain after Surgery (PELOPS trial) in orthopedic patients—study protocol for a randomized controlled trial

BackgroundSuccessful pain management after outpatient surgery requires proper education leading to correct decisions on the analgesics use at home. Despite different strategies adopted, up to ½ of patients receive little or no information about the treatment of postoperative pain, 1/3 of them are not able to follow postoperative analgesia instructions. This leads to higher rates of unmet needs in pain treatment, post-discharge emergency calls, and readmissions. Structured educational interventions using psychological empowering techniques may improve postoperative pain management. We hypothesize that preoperative education on use of an improved pain scale to make correct pain management decisions will improve the quality of post-operative pain management at home and reduce analgesics-related side effects.MethodsA total of 414 patients scheduled for an outpatient orthopedic surgery (knee/shoulder arthroscopic interventions) are included in this randomized (1:1) controlled trial. Patients in the control arm receive standard information on post-discharge pain management. Patients in the experimental arm receive structured educational intervention based on the rational perception of postoperative pain and discomfort (anchoring and improved pain scale), and the proper use of analgesics. There is no difference in post-discharge analgesics regimen in both arms. Patients are followed for 30 days post-discharge, with the primary outcome expressed as total pain relief score at 5 days. Secondary outcomes include the incidence of severe pain during 30 days, changes in sleep quality (Pittsburg Sleep Quality Assessment), and patients’ perception of postoperative pain management assessed with the International Pain Outcomes questionnaire at day 30 post-discharge.DiscussionThe developed intervention, based on an improved pain scale, offers the advantages of being non-surgery-specific, is easily administered in a short amount of time, and can be delivered individually or in-group, by physicians or nurses.Trial registrationClinicalTrials.govNCT03754699. Registered on November 27, 2018.

Patient and in-hospital predictors of post-discharge opioid utilization: Individualizing prescribing after radical prostatectomy based on the ORIOLES initiative.

Judicious opioid stewardship would match each patient's prescription to their true medical necessity. However, most prescribing paradigms apply preset quantities and clinical judgment without objective data to predict individual use. We evaluated individual patient and in-hospital parameters as predictors of post-discharge opioid utilization after radical prostatectomy (RP) to provide evidence-based guidance for individualized prescribing. A prospective cohort of patients who underwent open or robotic RP were followed in the Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery (ORIOLES) initiative. Baseline demographics, in-hospital parameters, and inpatient and post-discharge pain medication utilization were tabulated. Opioid medications were converted to oral morphine equivalents (OMEQ). Predictive factors for post-discharge opioid utilization were analyzed by univariable and multivariable linear regression, adjusting for opioid reduction interventions performed in ORIOLES. Of 443 patients, 102 underwent open and 341 underwent robotic RP. The factors most strongly associated with post-discharge opioid utilization included inpatient opioid utilization in the final 12 hours before discharge (+39.6 post-discharge OMEQ if inpatient OMEQ was >15 vs. 0), maximum patient-reported pain score (range 0-10) in the 12 hours before discharge (+27.6 OMEQ for pain score ≥6 vs. ≤1), preoperative opioid use (+76.2 OMEQ), and body mass index (BMI; +1.4 OMEQ per 1 kg/m2). A final predictive calculator to guide post-discharge opioid prescribing was constructed. Following RP, inpatient opioid use, patient-reported pain scores, prior opioid use, and BMI are correlated with post-discharge opioid utilization. These data can help guide individualized opioid prescribing to reduce risks of both overprescribing and underprescribing.

Postdischarge pain, nausea and patient satisfaction after diagnostic and breast-conserving ambulatory surgery for breast cancer: A cross-sectional study.

The aims of this study were to assess first day postdischarge pain, nausea and patient satisfaction in ambulatory breast cancer surgical patients, after diagnostic and breast conserving procedures. A total of 781 women, aged 18-85years were included in this prospective, cross-sectional study. All patients received standardized multimodal pain prophylaxis with paracetamol, COX-II inhibitor, dexamethasone and wound infiltration with local anaesthetics. Nausea prophylaxis was provided with ondansetron. Most patients received general anaesthesia with propofol and remifentanil. Data were collected using a validated questionnaire during telephone follow-up on the first postoperative day. The response rate was 94.5%. NRS≥4 was reported by 5.3% at rest, by 17% during activity and by 30.7% as the worst pain score. Young age was strongly associated with more pain both at rest, during activity and regarding worst pain since discharge. Postdischarge nausea was present in 17.8%, and vomiting in 1.2%. High pain score during activity and higher level of worst pain, were associated with nausea. There was no association between nausea and age, type of anaesthesia, surgical procedure or pain at rest. Patient satisfaction was high (97.8%-99.7%) regarding information, time for discharge and overall satisfaction. Pain scores and incidence of nausea were generally low on the day after surgery. Young age was a strong predictor for postdischarge pain. A high worst pain score and high pain score during the activity were associated with postdischarge nausea. Patient satisfaction was high.

Pilot implementation of opioid stewardship measures using the national surgical quality improvement program-pediatric platform

IntroductionData surrounding optimal pediatric postoperative opioid prescribing are incomplete. The objective of this study was to leverage the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric (NSQIP-P) and assess feasibility of added data collection surrounding pediatric perioperative pain management practices including opioid prescribing at discharge. MethodsNineteen (19) novel data elements were added to NSQIP-P data collection of selected patients, ages 5–18 years, who had undergone surgery at a single, free-standing children's hospital. Metrics around data abstraction and completion of variables were collected. Univariate analyses (using Chi-square or Wilcoxon Rank Sum tests) and multiple logistic regressions were performed to describe predictors of opioid prescribing at discharge and to monitor adherence to Food and Drug Administration (FDA) prescribing recommendations. ResultsMedian abstraction time of the novel variables decreased from 12 to 5 min per patient over 13 months with 94% variable completion rate. Of 878 patients, 302 (36.4%) were prescribed opioids at discharge. Factors associated with an opioid prescription included older age (p < 0.001), white race (p < 0.05), undergoing an orthopedic surgery (p < 0.001), and receiving a regional block perioperatively (p < 0.001). All opioid prescriptions met FDA guidelines with no patients receiving codeine, and 98% of patients receiving opioid prescriptions < 50 morphine milli-equivalents per day. ConclusionCollecting data on current pain management practices, opioid prescribing, and adherence to safety recommendations is feasible using the NSQIP-P with little added burden. Further expansion of data collection is needed to develop generalizable optimal prescribing practices for post-discharge pain management for children.

Facilitators and barriers to post-discharge pain assessment and triage: a qualitative study of nurses\u2019 and patients\u2019 perspectives

BackgroundAfter hospital discharge, patients can experience symptoms prompting them to seek acute medical attention. Early evaluation of patients’ post-discharge symptoms by healthcare providers may improve appropriate healthcare utilization and patient safety. Post-discharge follow-up phone calls, which are used for routine transitional care in U.S. hospitals, serve as an important channel for provider-patient communication about symptoms. This study aimed to assess the facilitators and barriers to evaluating and triaging pain symptoms in cardiovascular patients through follow-up phone calls after their discharge from a large healthcare system in Central Massachusetts. We also discuss strategies that may help address the identified barriers.MethodsGuided by the Practical, Robust, Implementation and Sustainability Model (PRISM), we completed semi-structured interviews with 7 nurses and 16 patients in 2020. Selected nurses conducted (or supervised) post-discharge follow-up calls on behalf of 5 clinical teams (2 primary care; 3 cardiology). We used thematic analysis to identify themes from interviews and mapped them to the domains of the PRISM model.ResultsParticipants described common facilitators and barriers related to the four domains of PRISM: Intervention (I), Recipients (R), Implementation and Sustainability Infrastructure (ISI), and External Environment (EE). Facilitators include: (1) patients being willing to receive provider follow-up (R); (2) nurses experienced in symptom assessment (R); (3) good care coordination within individual clinical teams (R); (4) electronic health record system and call templates to support follow-up calls (ISI); and (5) national and institutional policies to support post-discharge follow-up (EE). Barriers include: (1) limitations of conducting symptom assessment by provider-initiated follow-up calls (I); (2) difficulty connecting patients and providers in a timely manner (R); (3) suboptimal coordination for transitional care among primary care and cardiology providers (R); and (4) lack of emphasis on post-discharge follow-up call reimbursement among cardiology clinics (EE). Specific barriers for pain assessment include: (1) concerns with pain medication misuse (R); and (2) no standardized pain assessment and triage protocol (ISI).ConclusionsStrategies to empower patients, facilitate timely patient-provider communication, and support care coordination regarding pain evaluation and treatment may reduce the barriers and improve processes and outcomes of pain assessment and triage.

MP34-15 INPATIENT METRICS PREDICT POST-DISCHARGE OPIOID USE: INDIVIDUALIZING PRESCRIBING AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety II (MP34)1 Sep 2021MP34-15 INPATIENT METRICS PREDICT POST-DISCHARGE OPIOID USE: INDIVIDUALIZING PRESCRIBING AFTER RADICAL PROSTATECTOMY Russell Becker, Zhou Su, Mitchell Huang, Michael Biles, Kelly Harris, Kevin Koo, Misop Han, Mohamad Allaf, Amin Herati, and Hiten Patel Russell BeckerRussell Becker More articles by this author , Zhou SuZhou Su More articles by this author , Mitchell HuangMitchell Huang More articles by this author , Michael BilesMichael Biles More articles by this author , Kelly HarrisKelly Harris More articles by this author , Kevin KooKevin Koo More articles by this author , Misop HanMisop Han More articles by this author , Mohamad AllafMohamad Allaf More articles by this author , Amin HeratiAmin Herati More articles by this author , and Hiten PatelHiten Patel More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002043.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Judicious opioid stewardship is imperative, and ideally matches each patient’s prescription to their true medical necessity. However, minimal objective data exist to guide prescribers in fulfilling this mission. We evaluated in-hospital parameters as predictors of post-discharge opioid utilization in a large cohort of patients undergoing radical prostatectomy (RP), to help provide objective evidence-based guidance for individualized prescribing. METHODS: A prospective cohort of 443 patients who underwent open or robotic RP between August 2017 and November 2018 were followed in the IRB-approved Opioid Reduction Intervention for Open, Laparoscopic, and Endoscopic Surgery (ORIOLES) initiative. Baseline demographics, clinical variables, patient-reported pain scores (scale 0-10), and inpatient and post-discharge pain medication utilization were tabulated from electronic medical records and planned 30-day follow-up physician telephone calls. All opioid medications were converted to oral morphine equivalents (OMEQ). Predictive factors for post-discharge opioid utilization were analyzed by univariate and multivariate linear regression, adjusting for opioid reduction interventions performed in the ORIOLES initiative. RESULTS: Of 443 patients (102 open and 341 robotic RP), 374 (84%) were discharged on post-operative day 1. On univariable analysis, the factors most strongly associated with post-discharge opioid utilization included inpatient opioid utilization (overall, average per day, and in the 12 hours prior to discharge; Pearson’s correlation coefficients r=0.34-0.38, p<0.001), maximum patient-reported pain scores (24 hours, 12 hours, and final score prior to discharge; r=0.26-0.32, p<0.001), and history of prior opioid use. On multivariable analysis, inpatient opioid use (+0.7 post-discharge OMEQ per 1 inpatient OMEQ) and maximum pain score (+5.5 post-discharge OMEQ per 1 point) in the final 12 hours prior to discharge remained significantly correlated with post-discharge utilization. A final predictive model to guide post-discharge prescribing was constructed (C-statistic for predicting various levels of post-discharge use ranged from 0.71-0.76). CONCLUSIONS: Following RP, inpatient opioid use, patient-reported pain scores, and prior opioid use are strongly correlated with post-discharge opioid utilization. These data can help guide individualized opioid prescribing at hospital discharge to more reliably meet individual needs while minimizing risks of overprescribing. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e622-e622 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Russell Becker More articles by this author Zhou Su More articles by this author Mitchell Huang More articles by this author Michael Biles More articles by this author Kelly Harris More articles by this author Kevin Koo More articles by this author Misop Han More articles by this author Mohamad Allaf More articles by this author Amin Herati More articles by this author Hiten Patel More articles by this author Expand All Advertisement Loading ...

The effect of regional anesthesia blocks on post-operative pain after ambulatory orthopedic trauma surgery.

To determine if regional anesthesia had added benefit to general anesthesia, with or without local anesthesia, in controlling post-operative pain in outpatient orthopedic trauma surgery. A retrospective review was performed of prospectively gathered data on 71 patients undergoing outpatient orthopedic trauma surgery. All patients received general anesthesia and an addition 52 patients received additional regional anesthesia. Regional vs. no regional anesthesia groups were compared in terms of post-anesthesia care unit (PACU) pain visual analog scores (VAS), PACU length of stay (LOS), opioid use, and pain control at two weeks. The regional anesthesia group not differ in demographics or proportion of patients receiving local anesthesia, but was less likely to be undergoing major procedures (13% vs. 37%, proportional difference (PD) -23%; 95% confidence interval (CI) -46% to -0.4%). There were no detectable differences in PACU opioid requirements (median difference (MD) -7.5mg, CI -8 to 0), PACU LOS (MD -13min, CI -63 to 24), discharge pain VAS (MD 0, CI -1 to 1), post-discharge pain VAS (MD 0, CI -1 to 1), opioid refills (PD -6%, CI -31% to 18%), or patient-perceived pain control (PD -24%, CI -41% to 0%). On multivariate analysis, regional anesthesia was the only variable negatively associated with patient-perceived pain control at two weeks (Odds Ratio 0.15; 95% CI 0.03 to 0.8). Regional anesthesia did not improve post-operative opioid requirements, PACU LOS, or patient-reported pain in the immediate or short-term post-operative period.

Non-specific pain and 30-day readmission in acute coronary syndromes: findings from the TRACE-CORE prospective cohort

BackgroundPatients with acute coronary syndromes often experience non-specific (generic) pain after hospital discharge. However, evidence about the association between post-discharge non-specific pain and rehospitalization remains limited.MethodsWe analyzed data from the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) prospective cohort. TRACE-CORE followed patients with acute coronary syndromes for 24 months post-discharge from the index hospitalization, collected patient-reported generic pain (using SF-36) and chest pain (using the Seattle Angina Questionnaire) and rehospitalization events. We assessed the association between generic pain and 30-day rehospitalization using multivariable logistic regression (N = 787). We also examined the associations among patient-reported pain, pain documentation identified by natural language processing (NLP) from electronic health record (EHR) notes, and the outcome.ResultsPatients were 62 years old (SD = 11.4), with 5.1% Black or Hispanic individuals and 29.9% women. Within 30 days post-discharge, 87 (11.1%) patients were re-hospitalized. Patient-reported mild-to-moderate pain, without EHR documentation, was associated with 30-day rehospitalization (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.14–3.62, reference: no pain) after adjusting for baseline characteristics; while patient-reported mild-to-moderate pain with EHR documentation (presumably addressed) was not (OR: 1.23, 95% CI: 0.52–2.90). Severe pain was also associated with 30-day rehospitalization (OR: 3.16, 95% CI: 1.32–7.54), even after further adjusting for chest pain (OR: 2.59, 95% CI: 1.06–6.35).ConclusionsPatient-reported post-discharge generic pain was positively associated with 30-day rehospitalization. Future studies should further disentangle the impact of cardiac and non-cardiac pain on rehospitalization and develop strategies to support the timely management of post-discharge pain by healthcare providers.

The Association between Implementation of an Enhanced Recovery after Cesarean Pathway with Standardized Discharge Prescriptions and Opioid Use and Pain Experience after Cesarean Delivery.

This study was aimed to evaluate opioid use after cesarean delivery (CD) and to assess implementation of an enhanced recovery after CD (ERAS-CD) pathway and its association with inpatient and postdischarge pain control and opioid use. We conducted a baseline survey of women who underwent CD from January to March 2017 at a single, urban academic hospital. Patients were called 5 to 8 days after discharge and asked about their pain and postdischarge opioid use. An ERAS-CD pathway was implemented as a quality improvement initiative, including use of nonopioid analgesia and standardization of opioid discharge prescriptions to ≤25 tablets of oxycodone of 5 mg. From November to January 2019, a postimplementation survey was conducted to assess the association between this initiative and patients' pain control and postoperative opioid use, both inpatient and postdischarge. Data were obtained from 152 women preimplementation (PRE) and 137 women post-implementation (POST); complete survey data were obtained from 102 women PRE and 98 women POST. The median inpatient morphine milligram equivalents consumed per patient decreased significantly from 141 [range: 90-195] PRE to 114 [range: 45-168] POST (p = 0.002). On a 0- to 10-point scale, median patient-reported pain scores at discharge decreased significantly (PRE: 7 [range: 5-8] vs. POST 5 [range: 3-7], p < 0.001). The median number of pills consumed after discharge also decreased significantly (PRE: 25 [range: 16-30] vs. POST 17.5 [range: 4-25], p = 0.001). The number of pills consumed was significantly associated with number prescribed (p < 0.001). The median number of leftover pills and number of refills did not significantly differ between groups. Median patient-reported pain scores at the week after discharge were lower in the POST group (PRE: 4 [range: 2-6] vs. POST 3[range: 1-5], p = 0.03). Implementing an ERAS-CD pathway was associated with a significant decrease in inpatient and postdischarge opioid consumption while improving pain control. Our data suggest that even fewer pills could be prescribed for some patients. · An ERAS-CD pathway was associated with decreased opioid use.. · Outpatient opioid consumption after cesarean warrants further study.. · Physician prescribing drives patients' opioid consumption..

Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service.

Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child's pain management and perceptions of support from the NpAPS. Parents completed the Parents' Postoperative Pain Measure-Short Form (PPPM-SF) and factors affecting parents' participation in children's pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.

Older Women and Opioid Analgesia after Breast Cancer Surgery

PurposeTo explore which factors influence opioid analgesia use in older women during the 48-hour period after hospital discharge following initial breast cancer surgery. DesignThis cross-sectional, descriptive study involved a cohort (n = 57) of older women recruited for a larger study of breast cancer patients. MethodsWe gathered patient-reported data pertinent to perioperative and post-discharge pain control. Data were analyzed using linear regression to explore those characteristics that had the greatest influence on the amount of post-discharge opioid analgesia required. ResultsAfter hospital discharge, 29 older women (51%) with breast cancer avoided opioid analgesia for various reasons. The number of prescribed opioid tablets each woman self-administered determined the total dosage of analgesia required 48 hours post-discharge. ConclusionsThe majority of this sample of older women with early-stage breast cancer experienced adequate pain relief after surgery and required little or no postoperative or postdischarge opioid analgesia. Optimization of the pain control experience for older women with breast cancer requires thorough pain assessment from diagnosis through survivorship through the end of life. This can be achieved by equipping women in this population to advocate for their pain control needs in real time. Future studies that elucidate preferences, beliefs, and current pain control practices before, during, and after breast cancer surgery will improve safety and efficacy of pain control for this fast-growing population.

Reduction of Opioid Quantities at Discharge After TKA Did Not Increase the Risk of Manipulation Under Anesthesia: An Institutional Experience

BackgroundIn response to the opioid epidemic, our arthroplasty service sequentially reduced the opioid quantities prescribed at primary total knee arthroplasty (TKA) discharge. However, its effect on postdischarge pain control and rehabilitation is unknown. We assessed if this decrease was associated with an increase in the risk of manipulation under anesthesia (MUA). MethodsWe retrospectively reviewed 8799 patients undergoing primary TKA from 2016 to 2019 at a single institution. There were two institution-wide reductions in the amount of opioids prescribed at discharge; therefore, we divided patients into 3 periods (P1, P2, and P3). The mean discharge morphine milligram equivalents (MMEs) went from 900 MMEs to ~525 MMEs to ~320 MMEs in P1, P2, and P3, respectively. We analyzed MUA rates and if lower discharge MMEs was a risk factor for MUA in a multivariate model. We also compared refill patterns (rates, number, refill MMEs, and total MMEs) between MUA and non-MUA patients. ResultsThe rate of MUA did not increase with reduced discharged opioids (5.5% in P1, 5.8% in P2, and 4.6% in P3, P = .74). In a multivariate analysis, discharge MMEs of <450 was not a significant risk factor for MUA. However, a diagnosis of chronic pain (OR = 1.86, P < .001) and an elevated body mass index (OR = 1.02 per unit increase, P < .001) were significant risk factors. We did not find significant differences in any opioid prescription refill patterns in MUA and non-MUA patients. ConclusionSerial reductions in discharge MMEs after primary TKA did not significantly affect the rate of MUA, a surrogate marker for pain control and the rehabilitative process.