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

Inference for a Progressive-Stress Model Based on Ordered Ranked Set Sampling under Type-II Censoring

The progressive-stress accelerated life test is discussed under the ordered ranked set sampling procedure. It is assumed that the lifetime of an item under use stress is exponentially distributed and the law of inverse power is considered as the relationship between the scale parameter and the applied stress. The involved parameters are estimated using the Bayesian technique, under symmetric and asymmetric loss functions, based on ordered ranked set samples and simple random samples subject to type-II censoring. Real and simulated data sets are used to illustrate the theoretical results presented in this paper. Finally, a simulation study followed by numerical calculations is performed to evaluate the Bayesian estimation performance based on the two sampling types

Inference on a New Lifetime Distribution under Progressive Type II Censoring for a Parallel-Series Structure

A new lifetime distribution, called exponential doubly Poisson distribution, is proposed with decreasing, increasing, and upside-down bathtub-shaped hazard rates. One of the reasons for introducing the new distribution is that it can describe the failure time of a system connected in the form of a parallel-series structure. Some properties of the proposed distribution are addressed. Four methods of estimation for the involved parameters are considered based on progressively type II censored data. These methods are maximum likelihood, moments, least squares, and weighted least squares estimations. Through an extensive numerical simulation, the performance of the estimation methods is compared based on the average of mean squared errors and the average of absolute relative biases of the estimates. Two real datasets are used to compare the proposed distribution with some other well-known distributions. The comparison indicates that the proposed distribution is better than the other distributions to match the data provided

Inference for the Exponential Distribution under Generalized Progressively Hybrid Censored Data from Partially Accelerated Life Tests with a Time Transformation Function

In this article, the tampered failure rate model is used in partially accelerated life testing. A non-decreasing time function, often called a ‘‘time transformation function", is proposed to tamper the failure rate under design conditions. Different types of the proposed function, which have sufficient conditions in order to be accelerating functions, are investigated. A baseline failure rate of the exponential distribution is considered. Some point estimation methods, as well as approximate confidence intervals, for the parameters involved are discussed based on generalized progressively hybrid censored data. The determination of the optimal stress change time is discussed under two different criteria of optimality. A real dataset is employed to explain the theoretical outcomes discussed in this article. Finally, a Monte Carlo simulation study is carried out to examine the performance of the estimation methods and the optimality criteria

Statistical Prediction Based on Ordered Ranked Set Sampling Using Type-II Censored Data from the Rayleigh Distribution under Progressive-Stress Accelerated Life Tests

The objective of ranked set sampling is to gather observations from a population that is more likely to cover the population’s full range of values. In this paper, the ordered ranked set sample is obtained using the idea of order statistics from independent and nonidentically distributed random variables under progressive-stress accelerated life tests. The lifetime of the item tested under normal conditions is suggested to be subject to the Rayleigh distribution with a scale parameter satisfying the inverse power law such that the applied stress is a nonlinear increasing function of time. Considering the type-II censoring scheme, one-sample prediction for censored lifetimes is discussed. Numerous point predictors including the Bayes point predictor, conditional median predictor, and best unbiased predictor for future order statistics are discussed. Additionally, conditional prediction intervals for future order statistics are also studied. The theoretical findings reported in this work are shown by illustrative examples based on simulated data as well as real data sets. The effectiveness of the prediction methods is then evaluated by a Monte Carlo simulation study

Reliability analysis of the triple modular redundancy system under step-partially accelerated life tests using Lomax distribution

Abstract Triple modular redundancy (TMR) is a robust technique utilized in safety-critical applications to enhance fault-tolerance and reliability. This article focuses on estimating the distribution parameters of a TMR system under step-stress partially accelerated life tests, where each component included in the system follows a Lomax distribution. The study aims to analyze the system’s reliability and mean residual lifetime based on the estimated parameters. Various estimation techniques, including maximum likelihood, percentile, least squares, and maximum product of spacings, are explored. Additionally, the optimal stress change time is determined using two criteria. An illustrative example supported by two actual data sets is presented to showcase the methodology’s application. By conducting Monte Carlo simulations, the assessment of the estimation methods’ effectiveness reveals that the maximum likelihood method outperforms the other three methods in terms of both accuracy and performance, as indicated by the numerical outcomes. This research contributes to the understanding and practical implementation of TMR systems in safety-critical industries, potentially saving lives and preventing catastrophic events

Classical and Bayesian Inference for the Kavya–Manoharan Generalized Exponential Distribution under Generalized Progressively Hybrid Censored Data

This manuscript focuses on the statistical inference of the Kavya–Manoharan generalized exponential distribution under the generalized type-I progressive hybrid censoring sample (GTI-PHCS). Different classical approaches of estimation, such as maximum likelihood, the maximum product of spacing, least squares (LS), weighted LS, and percentiles under GTI-PHCS, are investigated. Based on the squared error and linear exponential loss functions, the Bayes estimates for the unknown parameters utilizing separate gamma priors under GTI-PHCS have been derived. Point and interval estimates of unknown parameters are developed. We carry out a simulation using the Monte Carlo algorithm to show the performance of the inferential procedures. Finally, real-world data collection is examined for illustration purposes