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

Decomposing the rural-urban disparities in overweight and obesity among women of reproductive age in Nigeria

Abstract Background Overweight and obese women face various reproductive and other health challenges, and in some cases, even mortality. Despite evidence of rural-urban disparities in overweight and obesity among women of reproductive age, there is limited evidence regarding the predictors of these disparities. This study aims to investigate the factors associated with overweight and obesity and examine the contributors to rural-urban disparities in overweight and obesity among women of reproductive age in Nigeria. Methods We utilized the 2018 Nigeria Demographic and Health Survey dataset. The survey employed a two-stage cluster sampling technique based on Nigeria’s 2006 census enumeration areas for sample selection. Overweight and obesity were defined as a body mass index (BMI) ≥ 25. Data analyses were conducted using the Logistic Regression Model and the threefold Blinder-Oaxaca decomposition model (α0.05). Results The study revealed that older women (OR = 2.44; CI = 2.11–2.83), those with higher wealth (OR = 2.05; CI = 1.81–2.31), contraceptive users (OR = 1.41; CI = 1.27–1.57), and residents of the South-South region (OR = 1.24; CI = 1.07–1.45) were more likely to be overweight/obese. The decomposition analysis indicated that the mean predicted prevalence of overweight and obesity is 35.5% in urban areas, compared to 21.1% in rural areas of Nigeria. Factors such as wealth status, educational level, media exposure, and contraceptive use were identified as significant contributors to these disparities. Conclusion The findings underscore the importance of addressing socioeconomic disparities when designing healthcare interventions to reduce the burden of overweight and obesity, particularly in urban areas. Prioritizing these factors can facilitate efforts to promote healthier lifestyles and enhance overall well-being