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

Intent to participate in future cervical cancer screenings is lower when satisfaction with the decision to be vaccinated is neutral.

HPV vaccination programs have adversely affected participation in future cervical cancer screening. The purpose of this study is to determine the influence of decision satisfaction with accepting/rejecting the HPV vaccine, as well as traditional clinical factors, on the intent to participate in future screening.From January 2011 through August 2012 women 18-26 years old presenting for health care in an urban college student health and wellness clinic in the US Midwest were asked to complete a descriptive and medical history survey including a six element decisional satisfaction survey scored on 5-point Likert scales, where the intent to participate in future cervical cancer screening was measured. Of the 568 women who completed the decisional satisfaction survey, 17% of those <21 years and 7% ≥ 21 years indicated no intent to participate in future cervical cancer screenings. Among women of current screening age, the univariate risk factors of race/ethnicity, contraceptive use, number of lifetime sexual partners, and receipt of HPV vaccine were not predictors of intent for future cervical cancer screening. Instead, only a history of a prior Pap test was a significant positive predictor and only a decisional satisfaction of 'neutral' (Likert score = 3) for any of the four decisional satisfaction elements was a significant negative predictor. For the decisional satisfaction element "best for me personally", there was a 78% decreased likelihood of intending to participate in future screening if the satisfaction was neutral rather than firm (aOR = 0.22, 95% CI: 0.05-0.91) and a 26 fold increased likelihood if she had had a prior Pap test (aOR = 26, 95% CI: 5-133).HPV vaccination implementation programs must help women be the owner of their decision around HPV vaccination and understand the importance of future participation in cervical cancer screening

Women have a preference for their male partner to be HPV vaccinated.

BACKGROUND:Peer influence and social networking can change female adolescent and young adult behavior. Peer influence on preferences for male human papillomavirus (HPV) vaccination has not been documented. The primary aim of this study was to determine if women had preferences about male sexual partner HPV vaccination receipt. METHODS AND FINDINGS:A prospective survey of women 18-26 years of age was conducted at an urban university student health clinic. Education about the two HPV vaccines, cervical cancer and genital warts was provided. Women self-reported their demographic and medical history data, as well as their own preferences for HPV vaccine and their preferences for their male partner HPV vaccine using a 5 point Likert scale. 601 women, mean age of 21.5 years (SD 2.4), participated between 2011 and 2012. Nearly 95% of respondents were heterosexual; condoms and contraceptives were used in over half of the population. Regardless of the woman's vaccination status, women had significantly higher (strongly agree/agree) preferences for the male partner being vaccinated with HPV4 than not caring if he was vaccinated (63.6% vs. 13.1%, p<0.001). This preference was repeated for sexual risk factors and past reproductive medical history. Women who received HPV4 compared to those choosing HPV2 had a significantly lower proportion of preferences for not caring if the male partner was vaccinated (13% vs. 22%, p = 0.015). CONCLUSIONS:Women preferred a HPV vaccinated male partner. Peer messaging might change the male HPV vaccination uptake

Predictors of intent to participate in cervical cancer screening.

<p>Bold numbers indicate statistical significance.</p><p>*Firm decision means the satisfaction score for the category was strongly agree/agree/disagree/strongly disagree.</p>†<p>The summary score was created from the sum of four dichotomous satisfaction categories (“personally”, “my personal values”, “mine to make” and “satisfied”) where the category was a 0 if neutral or a 1 if firm (strongly agree/agree/disagree/strongly disagree). Decisional satisfaction summary scores ranged from 0–4; 0 means that all four elements were ranked as neutral and 4 means that none of the four elements were ranked as neutral.</p

Women's preference rankings for her male partner's vaccination status by her reproductive medical history.

<p>*Women not already vaccinated and choosing HPV2 for herself had a significantly higher proportion of high rankings regarding not caring if her male partner is vaccinated with HPV4 than do vaccinated women (31% vs. 17%, p = 0.007).</p

Subject descriptors by age group and intent to participate in cervical cancer screening.

<p>Percentages are within intent to Pap grouping.</p>†<p>excluded from analyses.</p><p>Bold indicates statistical significance.</p

Decisional satisfaction by age group and intent to participate in cervical cancer screening.

<p>Bold decisional elements are those that showed a statistically significant difference in the proportion of neutral responses between those intending to be screened and those with no future intentions of participating in cervical cancer screening.</p

Univariate predictors of positive intent to participate in cervical cancer screening by age group by demographics.

<p>*all women with at least one pregnancy intended to continue cervical cancer screening.</p><p>Bold font indicates statistical significance.</p

Women's preference rankings for her male partner's vaccination status.

<p>*Women not already vaccinated and choosing HPV2 had a significantly lower proportion of strongly agree/agree rankings regarding having her male partner be vaccinated with HPV4 than do vaccinated women (70% vs. 75%, p = 0.049).</p>†<p>Women not already vaccinated and choosing HPV2 had a significantly higher proportion of strongly agree/agree rankings regarding having her male partner be vaccinated with HPV4 than do vaccinated women (22% vs. 13%, p = 0.015).</p