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

Eco-Efficiency Analysis of Integrated Waste Management Strategies Based on Gasification and Mechanical Biological Treatment

Integrated solid waste management (ISWM) strategies are developed towards promoting sustainable approaches for handling waste. Recently, gasification and mechanical biological treatment (MBT) technologies were recognized as effective processes for treating municipal solid waste. This study investigates the feasibility of integrating gasification and MBT technologies in multiple ISWM strategies, compared to incineration- and anaerobic digestion (AD)-based strategies. A comprehensive techno-economic and environmental assessment was carried out to evaluate the performance of the examined ISWM strategies. The evaluation was based on the energy generation potential, carbon footprint, and life cycle costing (LCC). An eco-efficiency analysis was conducted to quantify the environmental costs by incorporating the carbon footprint and LCC results. The proposed strategies were applied for the city of Abu Dhabi, United Arab Emirates, based on local bylaws and guidelines. The analysis revealed that the gasification-based strategy had the highest energy production of 47.0 million MWh, followed by the incineration- (34.2 million MWh), AD- (17.2 million MWh), and MBT-based (14.9 million MWh) strategies. Results of the environmental analysis indicated that the MBT- and AD-based strategies contributed the least to global warming with greenhouse gas emissions of 4442 and 4539 GgCO2-eq, respectively, compared to the gasification- (9922 GgCO2-eq) and incineration-based (15,700 GgCO2-eq) strategies. Furthermore, over a 25-year assessment period, the LCC findings demonstrated that the gasification- and MBT-based strategies were the most financially feasible with a positive net present value (NPV) of USD 364 and USD 284 million, respectively. The eco-efficiency analysis indicated that the MBT and gasification strategies are the most sustainable among the examined strategies. The sustainability of the assessed systems was improved by implementing policy and legal reforms, including incentive programs, less stringent bylaws on digestate, and encouraging source separation of wastes. Overall, this research emphasized the potential environmental and financial benefits of incorporating MBT and gasification technologies into ISWM strategies