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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Antifungal efficacy of phytoconstituents of Medicago sativa against Rhizoctonia solani

This research was carried out to study the antifungal properties of Medicago sativa L. against phytopathogenic fungus Rhizoctonia solani J.G. Kühn. Methanolic extract of M. sativa was estimated in vitro against the R. solani. M. sativa methanolic extract was found to be highly efficient at the concentration of 5% as it reduced 74% test fungus biomass. Test plant was further partitioned by five organic fractions namely, n-butanol, chloroform, ethyl acetate, acetone and n-hexane. These isolated fractions and synthetic fungicide control group were evaluated in vitro against R. solani. Results showed that ethyl acetate fraction and fungicide were most effectively to repress the growth of R. solani up to 61-67%. This ethyl acetate fraction was further carried out for analysis of GC-MS and nine bioactive agents were found. The most copious compounds were phytol (RT: 20.84), 1,2,3-Propanetriol, monoacetate (RT: 12.47), Z,Z-3, 15-Octadecadien-1-olacetate (RT: 21.75), Hexadecanoic acid, ethyl ester (RT: 19.72) and Benzene, nitro- (RT: 10.20). The present study can be concluded that M. sativa possesses antifungal constituents against R. solani.Cette recherche a été menée afin d’étudier les propriétés antifongiques de Medicago sativa L. contre le champignon phytopathogène Rhizoctonia solani J.G. Kühn. L’extrait méthanolique de M. sativa contre R. solani a été évalué in vitro. L’extrait méthanolique de M. sativa s’est avéré très efficace à une concentration de 5%, car il réduisait de 74% la biomasse du champignon à l’essai. L’extrait de plante a ensuite été divisé en cinq fractions organiques à savoir le n-butanol, le chloroforme, l’acétate d’éthyle, l’acétone et le n-hexane. Ces fractions isolées et le groupe témoin de fongicide synthétique ont été évalués in vitro contre R. solani. Les résultats ont montré que la fraction d’acétate d’éthyle et le fongicide étaient les plus efficaces pour réprimer la croissance de R. solani jusqu’à 61-67%. Cette fraction d’acétate d’éthyle a ensuite été analysée par CPG-SM et neuf agents bioactifs ont été trouvés. Les composés les plus abondants étaient le phytol (TR : 20,84), le 1,2,3-Propanetriol, monoacétate (TR : 12,47), Z,Z-3, 15-Octadécadien-1-olacétate (TR : 21,75), l’acide hexadécanoïque, ester (TR : 19,72) et le benzène, nitro- (TR : 10,20). La présente étude peut être conclue que M. sativa possède des constituants antifongiques contre R. solani

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population