Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Factors influencing stress and resilience among Egyptian medical students: a multi-centric cross-sectional study

Abstract Background Psychological stress is a common psychological comorbidity among medical students and worsens their quality of life. Psychological resilience is thought to have a protective role against stress. However, evidence regarding the prevalence of stress and resilience alongside their associated factors is scarce, especially in the Middle East. This is the first multicenter, cross-sectional study to investigate resilience and stress among Egyptian medical students. Methods The current cross-sectional study was conducted on 2465 university students in seven public universities in Egypt. The universities were selected using the simple randomization method. The data was collected using a self-administered questionnaire consisting of four parts: demographic data, socioeconomic tool represented in the Family Affluence Scale (FAS), the Kessler Psychological Distress Scale (K10), and the Brief Resilience Scale (BRS). Data was analyzed in SPSS version 26 software. Results The majority of the students were stressed (86.5%), most of whom had severe stress (48.9%). Most of the students had low resilience (49.9%), while only 3.2% had high resilience. In the logistic regression analysis, being a female, living alone, spending long hours on social media, and thinking of suicide or leaving medicine were associated with being stressed and having low resilience. Medical students with low resilience were significantly more liable to stress [Adjusted odds ratio (AOR) = 3.667, confidence interval (CI): 2.709–4.965, P = 0.000], and vice versa [AOR = 3.709, CI: 2.746–5.009, P = 0.000]. Interestingly, high socioeconomic status showed a significant association with high resilience (P = 0.004); nonetheless, it was not associated with stress (P = 0.993). Academic grades were not associated with both the level of stress and resilience. Aging, being in clinical or academic stages, smoking, having a chronic disease, and being financially-supported are neither associated with stress nor resilience. Conclusions The present study revealed that Egyptian medical students had low resilience and high stress, with a significant relationship between both of them. Further investigations via longitudinal study design to understand the resilience-stress relationship are recommended. Developing and implementing resilience-improving strategies in medical schools is highly recommended to decrease the prevalence of stress and its subsequent burdens

Efficacy of membranectomy for the treatment of chronic subdural hematoma: an updated meta-analysis

Abstract Background Chronic subdural hematoma is a prevalent neurosurgical condition that necessitates surgical intervention. However, initial management remains controversial. This meta-analysis aimed to determine the benefits of Membranectomy when performed in conjunction with other neurosurgical interventions. Methods A systematic search was conducted in four electronic databases (PubMed, Cochrane Library, Web of Science, and Scopus) for eligible comparative studies until January 2024. Five primary outcomes were assessed. OpenMeta[Analyst] software was utilized for data analysis, and a p-value ≤ 0.05 was considered statistically significant. Results This meta-analysis encompassed 16 studies involving 2243 patients. The combined mean mortality, major complications, and reoperation rates were 6.9% (95% CI: 3.1–10.8%, p < 0.001), 17.5% (95% CI: 11.3–23.7%, p < 0.001), and 13.3% (95% CI: 7.7–18.5%, p < 0.001), respectively. The collective mean recurrence rate was 15.3% (95% CI: 10.2–20.3%, p < 0.001). Additionally, the collective mean length of hospital stay was 30.7 days (95% CI: 19.02–42.29, p < 0.001). Conclusion While membranectomy may reduce recurrence rates of CSDH in some cases, it is linked to higher mortality, complications, reoperations, and more extended hospital stays. Variability in techniques and patient factors complicates interpretation, and the retrospective nature of most studies limits definitive conclusions. Hence, membranectomy may benefit select patients, but its risks must be carefully considered. Further large-scale RCTs are needed to determine its safety and efficacy