Waking Up in Pain: a prospective unselected cohort study of pain in 3702 patients immediately after surgery in the Danish Realm

2021 ◽  
pp. rapm-2021-102583 ◽  
Author(s):  
Anders Mølgaard Rasmussen ◽  
Mette Helene Toft ◽  
Hussein Nasser Awada ◽  
Jesper Dirks ◽  
Birgitte Brandsborg ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Postoperative Pain ◽  
Severe Pain ◽  
Large Scale ◽  
Public Hospitals ◽  
Postanesthesia Care Unit ◽  
Postoperative Phase ◽  
Preoperative Pain ◽  
Unselected Cohort

BackgroundAcute and persistent pain after surgery is well described. However, no large-scale studies on immediate postoperative pain in the operating room (OR) exist, hindering potential areas of research to improve clinical outcomes. Thus, we aimed to describe the occurrence and severity of immediate postoperative pain in a large, unselected cohort.MethodsThis was a prospective cohort study, encompassing all procedures in 31 public hospitals in the Danish Realm, during a 5-day period including the weekend. Data on procedures and anesthesia were collected and the main outcome was occurrence of moderate or severe pain in the OR. Secondary outcomes included pain, sedation and nausea in the OR or during the first 15 min in the postanesthesia care unit (PACU) including relevant risk factors. Descriptive and logistic regression statistics were used.ResultsA total of 3675 procedures were included for analysis (87% inclusion rate). Moderate or severe pain occurred in 7.4% (95% CI 6.5% to 8.3%) of cases in the OR immediately after awakening, rising to 20.2% in the OR and/or PACU. Large intraprocedure and interprocedure variations occurred (0.0%–37.5%), and in 20% of cases with epidural-general anesthesia patients experienced moderate or severe pain. Independent risk factors were female sex, younger age, preoperative pain, daily opioid use and major surgical procedures.ConclusionModerate or severe pain in the immediate postoperative phase occurred in 20% of all cases with procedure and anesthesiological technique variations, suggesting a need for identification of relevant procedure-specific risk factors and development of preventive treatments.Trial registration numberRoPR ID 43191.

scholarly journals Severe acute postoperative pain self-reported by children after ambulatory surgeries: a cohort study

2021 ◽  
Vol 74 (suppl 4) ◽  
Author(s):  
Louise Amália de Moura ◽  
Lilian Varanda Pereira ◽  
Ruth Minamisava ◽  
Natália de Carvalho Borges ◽  
Thaila Corrêa Castral ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Postoperative Pain ◽  
Hospital Discharge ◽  
Surgical Procedures ◽  
Cox Regression ◽  
Preoperative Anxiety ◽  
Acute Postoperative Pain ◽  
Preoperative Pain ◽  
Severe Postoperative Pain

ABSTRACT Objectives: to estimate the incidence and the risk factors for severe acute postoperative pain self-reported on the first day after hospital discharge. Methods: cohort study with 279 children from both sexes (5-12 years old), indicated for ambulatory surgery in two Brazilian hospitals. Children were assessed at the pre-surgery, immediate postoperative and first postoperative day. Faces Pain Scale-Revised and Yale Preoperative Anxiety Scale Modified were used. Severe postoperative pain was defined as score ≥6. Cox regression analyses were used. Results: the incidence of severe postoperative pain was 15.8% (95%CI:10.7%-20.4%) on the first postoperative day. Preoperative anxiety (HR=2.23; p=0.049), severe preoperative pain (HR=2.78; p=0.031) and having undergone two surgical procedures (HR=2.91; p=0.002) were associated with severe postoperative pain. Conclusions the incidence of severe postoperative pain self-reported after hospital discharge was high. Anxiety and severe preoperative pain, in addition to performing two surgical procedures at the same time were confirmed as risk factors.

Surgical Site Infection After Primary Hip and Knee Arthroplasty: A Cohort Study Using a Hospital Database

2015 ◽  
Vol 36 (10) ◽  
pp. 1198-1207 ◽  
Author(s):  
Leslie Grammatico-Guillon ◽  
Sabine Baron ◽  
Philippe Rosset ◽  
Christophe Gaborit ◽  
Louis Bernard ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Knee Arthroplasty ◽  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Public Hospitals ◽  
Prosthetic Material ◽  
Hospital Database ◽  
Prosthetic Joint

BACKGROUNDHip or knee arthroplasty infection (HKAI) leads to heavy medical consequences even if rare.OBJECTIVETo assess the routine use of a hospital discharge detection algorithm of prosthetic joint infection as a novel additional tool for surveillance.METHODSA historic 5-year cohort study was built using a hospital database of people undergoing a first hip or knee arthroplasty in 1 French region (2.5 million inhabitants, 39 private and public hospitals): 32,678 patients with arthroplasty code plus corresponding prosthetic material code were tagged. HKAI occurrence was then tracked in the follow-up on the basis of a previously validated algorithm using International Statistical Classification of Disease, Tenth Revision, codes as well as the surgical procedures coded. HKAI density incidence was estimated during the follow-up (up to 4 years after surgery); risk factors were analyzed using Cox regression.RESULTSA total of 604 HKAI patients were identified: 1-year HKAI incidence was1.31%, and density incidence was 2.2/100 person-years in hip and 2.5/100 person-years in knee. HKAI occurred within the first 30 days after surgery for 30% but more than 1 year after replacement for 29%. Patients aged 75 years or older, male, or having liver diseases, alcohol abuse, or ulcer sore had higher risk of infection. The inpatient case fatality in HKAI patients was 11.4%.CONCLUSIONSThe hospital database method used to measure occurrence and risk factors of prosthetic joint infection helped to survey HKAI and could optimize healthcare delivery.Infect Control Hosp Epidemiol 2015;36(10):1198–1207

scholarly journals Risk Factors for Moderate-to-severe Postoperative Pain After Percutaneous Nephrolithotomy:A Retrospective Study

2021 ◽  
Author(s):  
Hao-Tian Wu ◽  
Tian-fu Ding ◽  
Huan Zhang
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Postoperative Pain ◽  
Severe Pain ◽  
Multivariate Logistic Regression Analysis ◽  
Renal Calculus ◽  
Multivariate Logistic Regression ◽  
Pain Group ◽  
Duration Of Surgery ◽  
Severe Postoperative Pain

Abstract Backgroud and Objectives: Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing renal calculus ,but a large number of patients experience acute moderate-to-severe pain despite the analgesia provided.The aim of this study is to explore the risk factors for postoperative pain after percutaneous nephrolithotomy (PCNL), and provides a reference for clinical prevention of postoperative pain after PCNL.Methods: According to the inclusion and exclusion criteria, the clinical data of 331 patients who underwent PCNL in our hospital from September 2019 to February 2021 were retrospectively collected. General anesthesia was induced with propofol, sufentanil and rocuronium and maintained with sevoflurane, remifentanil and rocuronium.Depending on whether the patient had moderate-to-severe postoperative pain, they were divided into mild or no pain group and moderate-to-severe pain group. We collected and analyzed data on age,gender, body mass index (BMI),ASA grading,co-morbidities,number of renal calculus,renal calculus size,degree of hydronephrosis,preoperative urine culture,preoperative creatinine,stone burdens,expansion method,tract diameter,nephrostomy tube,calculi residual,operative position ,puncture time ,number of expanded channels,expanded channel time, duration of surgery,vital signs and VAS pain score.The indicators with statistically significant differences were selected and multivariate logistic regression analysis was carried out to determine the risk factors for postoperative pain. Results: Among 331 patients, 221 had moderate-to-severe pain and the incidence rate was 66.77%. Univariate analysis and multivariate logistic regression analysis showed that independent risk factors for moderate-to-severe pain after PCNL were:number of renal calculus(OR=5.303，P=0.001),stone burdens (OR=7.623，P=0.001),calculi residual(OR=0.2377，P=0.001),duration of surgery (min)(OR=1.024， P=0.001). Conclusions: The main risk factors for pain after PCNL are number of renal calculus,stone burdens ,calculi residual and duration of surgery.

scholarly journals Epidemiology of neonatal infections in hospitals of Nepal: evidence from a large- scale study

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Shyam Sundar Budhathoki ◽  
Avinash K. Sunny ◽  
Pragya Gautam Paudel ◽  
Jeevan Thapa ◽  
Lila Bahadur Basnet ◽  
...  
Keyword(s):  
Risk Factors ◽  
Large Scale ◽  
Comparison Group ◽  
Mode Of Delivery ◽  
Clinical Signs ◽  
Birth Asphyxia ◽  
Newborn Care ◽  
Neonatal Infection ◽  
Public Hospitals ◽  
Neonatal Infections

Abstract Background Every year, neonatal infections account for approximately 750,000 neonatal deaths globally. It is the third major cause of neonatal death, globally and in Nepal. There is a paucity of data on clinical aetiology and outcomes of neonatal infection in Nepal. This paper aims to assess the incidence and risk factors of neonatal infection in babies born in public hospitals of Nepal. Methods This is a prospective cohort study conducted for a period of 14 months, nested within a large-scale cluster randomized control trial which evaluated the Helping Babies Breathe Quality Improvement package in 12 public hospitals in Nepal. All the mothers who consented to participate within the study and delivered in these hospitals were included in the analysis. All neonates admitted into the sick newborn care unit weighing > 1500 g or/and 32 weeks or more gestation with clinical signs of infection or positive septic screening were taken as cases and those that did not have an infection were the comparison group. Bivariate and multi-variate analysis of socio-demographic, maternal, obstetric and neonatal characteristics of case and comparison group were conducted to assess risk factors associated with neonatal infection. Results The overall incidence of neonatal infection was 7.3 per 1000 live births. Babies who were born to first time mothers were at 64% higher risk of having infection (aOR-1.64, 95% CI, 1.30–2.06, p-value< 0.001). Babies born to mothers who had no antenatal check-up had more than three-fold risk of infection (aOR-3.45, 95% CI, 1.82–6.56, p-value< 0.001). Babies born through caesarean section had more than two-fold risk (aOR-2.06, 95% CI, 1.48–2.87, p-value< 0.001) and babies with birth asphyxia had more than three-fold risk for infection (aOR-3.51, 95% CI, 1.71–7.20, p-value = 0.001). Conclusion Antepartum factors, such as antenatal care attendance, and intrapartum factors such as mode of delivery and birth asphyxia, were risk factors for neonatal infections. These findings highlight the importance of ANC visits and the need for proper care during resuscitation in babies with birth asphyxia.

Preoperative Pain is the Strongest Predictor of Postoperative Pain and Diminished Quality of Life after Ventral Hernia Repair

2013 ◽  
Vol 79 (8) ◽  
pp. 829-836 ◽  
Author(s):  
Victor B. Tsirline ◽  
Paul D. Colavita ◽  
Igor Belyansky ◽  
Allay Zemlyak ◽  
Amy E. Lincourt ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Postoperative Pain ◽  
Hernia Repair ◽  
Ventral Hernia ◽  
Severe Pain ◽  
The United States ◽  
Preoperative Pain ◽  
Patient Reported

With evolution of hernia repair surgery, quality of life (QOL) became a major outcome measure in nearly 350,000 ventral hernia repairs (VHRs) performed annually in the United States. This study identified predictors of chronic pain after VHR. A prospective database of patient-reported QOL outcomes at a tertiary referral center was queried from 2007 to 2010; 512 patients met inclusion criteria. Factors including demographics, medical comorbidities, preoperative symptoms, and hernia characteristics were analyzed using advanced statistical modeling. Average age was 56.4 years, 57.6 per cent were males, mean body mass index was 33 kg/m2, hernia defect size was 138 cm2, and 35.5 per cent were repaired laparoscopically. Preoperatively, 69 per cent of patients had mild and 28 per cent severe pain during some activities. Pain levels were elevated in the first month postoperatively; by 6 months, patients reported significant improvement. The most significant and consistent predictor of postoperative pain was the presence of preoperative pain (odds ratio, 2.1; 95% confidence interval, 1.4 to 3.0; P = 0.0001). Older patients and men had less postoperative pain, but they also had less preoperative pain, so these factors were not independent predictors. Patients with minimal preoperative symptoms uniformly experienced resolution of pain by 6 months postoperatively. Among patients with severe preoperative pain, one-third reported long-term resolution of pain, and one-third had persistent severe pain. The former group had smaller hernias (91 vs 194 cm2, respectively, P = 0.015). Cases of new-onset, long-term pain after VHR were rare (less than 2%). Most patients’ symptoms resolve by 6 months after surgery, but those with severe preoperative pain are at risk for persistent postoperative pain.

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