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 \u3c 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 (β 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

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

Delay in the diagnosis of pediatric central nervous system tumors: data from a single tertiary care center

Background: Central nervous system (CNS) tumors are among the most common solid tumors in pediatric patients. Timely diagnosis is crucial for effective management and improved outcomes. This study aimed to analyze the delay in diagnosis of CNS tumors at a single tertiary care hospital in Pakistan.Methods: A retrospective study was conducted on patients aged 0-21 years diagnosed with CNS tumors at Aga Khan University Hospital (AKUH) between January 2018 and December 2023. Data was reviewed from medical records via the hospital\u27s database. Time to diagnosis was recorded as the duration between initial symptoms and the first radiological diagnosis.Results: Three hundred thirty-eight patients were identified; 57.1% were male with a median age of 9 years (interquartile range (IQR): 5-14). The most common symptom was headache (55.6%), followed by vomiting (47.9%). Low-grade gliomas (24.3%) were predominant, followed by high-grade gliomas (21.6%) and medulloblastoma (14.2%). The median duration from symptom onset to diagnosis was 2.1 months (IQR: 1.0-6.3), whereas the median duration of symptoms to oncologist/neurosurgeon visit was 3 months (IQR: 1.0-8.6). Early tumor diagnosis correlated significantly with vomiting (p \u3c 0.001) and tumor location (p \u3c 0.001). Tumor diagnosis was within 2 months for medulloblastoma and high-grade glioma and more than 2 months for low-grade glioma and ependymoma (p = 0.003).Conclusion: Our findings depict a delay in referral to a neuro-oncologist or neurosurgeon. This warrants increased awareness among the general population and primary healthcare professionals. Public awareness campaigns and early recognition of symptoms followed by timely referral to tertiary healthcare centers are key for early diagnosis of pediatric CNS tumors

Pregnancy and cardiovascular disease in developing countries of South Asia—A narrative review

Abstract According to the World Health Organization, low-middle-income countries report higher maternal mortality rates in South Asia compared to higher-income countries. Pregnancy with cardiovascular diseases is a prominent contributor to these preventable deaths. Reasons behind poor maternal outcomes are multifactorial, including unstable healthcare systems, knowledge gaps, and sociocultural factors. This review discusses the concept of iceberg model, a tool for health system analysis to identify potential factors behind poor maternal outcomes