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

Impacts of Singapore Formula One Grand Prix : a perspective from local residents.

Successful large-scale events can help in promoting tourism and economic activity in a country, and the impacts brought by these events are felt by both the industry players and locals. This report attempts to investigate and identify the factors that constitute success for the Singtel Formula One (F1) Grand Prix Night Race event held in Singapore and offers recommendations to the organizers to improve on areas perceived as crucial to making an event similar to this successful. The survey results collated provided an insight into the perceptions of the Singaporean population about the F1 event. The general consensus was that the event was, by and large, a successful one, although not without some shortfalls in terms of service quality and prices. Moreover, the survey findings also showed that the benefits resulting from the F1 event were believed to outweigh the costs it entailed, notwithstanding some disturbances to the daily routines of Singaporeans, with respect to traffic and noise issues. The recommendations offered in this report are targeted at the areas which have been identified in the survey as having dampening effects on the impression of the F1 event. By channelling efforts to minimise these areas of concern, the end result would be an improvement to subsequent events. Recommendations tackle the major issues of traffic and prices.BUSINES