Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry

Pain after surgery remains a problem worldwide, although there are no published data on postoperative outcomes in Spain. We evaluated 2,922 patients on the first day after surgery in 13 tertiary care Spanish hospitals, using the PAIN-OUT questionnaire. The aims were to: assess postoperative outcomes...

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Autores: Polanco-García, Mauricio, García-Lopez, Jaume, Fàbregas, Neus, Meissner, Windfried, Puig, Margarita M.
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2017
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/34920
Acceso en línea:http://hdl.handle.net/10230/34920
http://dx.doi.org/10.1016/j.jpain.2017.05.006
Access Level:acceso abierto
Palabra clave:Dolor crònic - Cirurgia
Dolor postoperatori
Postoperative pain
Opioid consumption
Patient satisfaction
Postoperative analgesia
Postoperative outcomes
Pre-surgical chronic pain
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spelling Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT RegistryPolanco-García, MauricioGarcía-Lopez, JaumeFàbregas, NeusMeissner, WindfriedPuig, Margarita M.Dolor crònic - CirurgiaDolor postoperatoriPostoperative painOpioid consumptionPatient satisfactionPostoperative analgesiaPostoperative outcomesPre-surgical chronic painPain after surgery remains a problem worldwide, although there are no published data on postoperative outcomes in Spain. We evaluated 2,922 patients on the first day after surgery in 13 tertiary care Spanish hospitals, using the PAIN-OUT questionnaire. The aims were to: assess postoperative outcomes and anesthetic/analgesic management in Orthopedics (ORT) and General Surgery (GEN) patients; explore the influence of the analgesic therapy on outcomes and opioid requirements; evaluate and compare outcomes and analgesic management according to surgical procedure. Mean worst pain and percentage of patients in severe pain were 5.6 (on a numeric rating scale of 0-10) and 39.4%, respectively, slightly lower than those reported in Western countries (range, 5.0-8.4 and 33-55%). Patients' pain assessment (83.1%) and information were high (63.3%), but participation in decision-making (4.8) was lower than in the United States (7.0) and Europe (Germany, France, Norway, and Denmark; mean, 5.9). Patients after orthopedic surgery had the worst outcomes. General anesthesia was more frequent in GEN patients, whereas regional (central and peripheral) was more frequent in ORT surgery patients. Mean opioid consumption (20.2 mg per patient per 24 hours, oral morphine equivalents), was lower than reported and decreased >50% after regional analgesia. Intravenous morphine patient-controlled analgesia was seldom used (6.2%). Acute opioid treatments were associated with worsened outcomes whereas multimodal analgesia (mainly antipyretic analgesics-nonsteroidal anti-inflammatory drugs-opioids) were associated with improved results. Epidurals in abdominal surgery (16.7%) were also associated with better outcomes. Presurgical chronic pain (>7) and/or chronic opioid consumption, were associated with worsened pain outcomes; the latter with a 50% increase in postoperative opioid requirements. Tibia/fibula and foot surgeries (ORT), and gastric, small intestine, and anterior abdominal wall procedures (GEN) were the most painful. Rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve postoperative outcomes. PERSPECTIVE: We analyzed postoperative outcomes and analgesic management in patients from tertiary care Spanish hospitals. The study serves as a point of comparison with other Western countries and shows that pain intensity outcomes and opioid consumption were slightly better in the Spanish population. Chronic pain before surgery (numeric rating scale score >7) and/or chronic opioid consumption, were associated with worsened pain outcomes, suggesting that rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve outcomes. Patients' pain participation in decision-making was inadequate and should be improved in Spanish hospitals.The PAIN OUT project was funded by the European Commission 7th Framework Programme, Call HEALTH-2007- 3.1 4: Improving Clinical Decision-Making, and endorsed by the International Association for the Study of PainElsevier20182017info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/34920http://dx.doi.org/10.1016/j.jpain.2017.05.006reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésThe Journal of Pain. 2017 Oct;18(10):1237-52info:eu-repo/grantAgreement/EC/FP7/223590© Elsevier http://dx.doi.org/10.1016/j.jpain.2017.05.006info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/349202026-06-12T07:21:37Z
dc.title.none.fl_str_mv Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
title Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
spellingShingle Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
Polanco-García, Mauricio
Dolor crònic - Cirurgia
Dolor postoperatori
Postoperative pain
Opioid consumption
Patient satisfaction
Postoperative analgesia
Postoperative outcomes
Pre-surgical chronic pain
title_short Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
title_full Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
title_fullStr Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
title_full_unstemmed Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
title_sort Postoperative Pain Management in Spanish Hospitals: A Cohort Study Using the PAIN-OUT Registry
dc.creator.none.fl_str_mv Polanco-García, Mauricio
García-Lopez, Jaume
Fàbregas, Neus
Meissner, Windfried
Puig, Margarita M.
author Polanco-García, Mauricio
author_facet Polanco-García, Mauricio
García-Lopez, Jaume
Fàbregas, Neus
Meissner, Windfried
Puig, Margarita M.
author_role author
author2 García-Lopez, Jaume
Fàbregas, Neus
Meissner, Windfried
Puig, Margarita M.
author2_role author
author
author
author
dc.subject.none.fl_str_mv Dolor crònic - Cirurgia
Dolor postoperatori
Postoperative pain
Opioid consumption
Patient satisfaction
Postoperative analgesia
Postoperative outcomes
Pre-surgical chronic pain
topic Dolor crònic - Cirurgia
Dolor postoperatori
Postoperative pain
Opioid consumption
Patient satisfaction
Postoperative analgesia
Postoperative outcomes
Pre-surgical chronic pain
description Pain after surgery remains a problem worldwide, although there are no published data on postoperative outcomes in Spain. We evaluated 2,922 patients on the first day after surgery in 13 tertiary care Spanish hospitals, using the PAIN-OUT questionnaire. The aims were to: assess postoperative outcomes and anesthetic/analgesic management in Orthopedics (ORT) and General Surgery (GEN) patients; explore the influence of the analgesic therapy on outcomes and opioid requirements; evaluate and compare outcomes and analgesic management according to surgical procedure. Mean worst pain and percentage of patients in severe pain were 5.6 (on a numeric rating scale of 0-10) and 39.4%, respectively, slightly lower than those reported in Western countries (range, 5.0-8.4 and 33-55%). Patients' pain assessment (83.1%) and information were high (63.3%), but participation in decision-making (4.8) was lower than in the United States (7.0) and Europe (Germany, France, Norway, and Denmark; mean, 5.9). Patients after orthopedic surgery had the worst outcomes. General anesthesia was more frequent in GEN patients, whereas regional (central and peripheral) was more frequent in ORT surgery patients. Mean opioid consumption (20.2 mg per patient per 24 hours, oral morphine equivalents), was lower than reported and decreased >50% after regional analgesia. Intravenous morphine patient-controlled analgesia was seldom used (6.2%). Acute opioid treatments were associated with worsened outcomes whereas multimodal analgesia (mainly antipyretic analgesics-nonsteroidal anti-inflammatory drugs-opioids) were associated with improved results. Epidurals in abdominal surgery (16.7%) were also associated with better outcomes. Presurgical chronic pain (>7) and/or chronic opioid consumption, were associated with worsened pain outcomes; the latter with a 50% increase in postoperative opioid requirements. Tibia/fibula and foot surgeries (ORT), and gastric, small intestine, and anterior abdominal wall procedures (GEN) were the most painful. Rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve postoperative outcomes. PERSPECTIVE: We analyzed postoperative outcomes and analgesic management in patients from tertiary care Spanish hospitals. The study serves as a point of comparison with other Western countries and shows that pain intensity outcomes and opioid consumption were slightly better in the Spanish population. Chronic pain before surgery (numeric rating scale score >7) and/or chronic opioid consumption, were associated with worsened pain outcomes, suggesting that rigorous control of chronic pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively, might improve outcomes. Patients' pain participation in decision-making was inadequate and should be improved in Spanish hospitals.
publishDate 2017
dc.date.none.fl_str_mv 2017
2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/34920
http://dx.doi.org/10.1016/j.jpain.2017.05.006
url http://hdl.handle.net/10230/34920
http://dx.doi.org/10.1016/j.jpain.2017.05.006
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv The Journal of Pain. 2017 Oct;18(10):1237-52
info:eu-repo/grantAgreement/EC/FP7/223590
dc.rights.none.fl_str_mv © Elsevier http://dx.doi.org/10.1016/j.jpain.2017.05.006
info:eu-repo/semantics/openAccess
rights_invalid_str_mv © Elsevier http://dx.doi.org/10.1016/j.jpain.2017.05.006
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Elsevier
publisher.none.fl_str_mv Elsevier
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
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