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

Arterial bending angle and wall morphology correlate with slow coronary flow: Determination with multidetector CT coronary angiography

WOS: 000286194700018PubMed ID: 19647387Background and purpose: The purpose of this study was to assess angulations and vessel wall morphology that could lead to bending head loss in the RCA and LMCA arteries of patients with slow coronary flow (SCF) evaluated by MDCT coronary angiography. Methods: The study involved 51 patients (45 males, mean age: 59.6 years) who were diagnosed with SCF by coronary angiography. Diagnosis of SCF was based on thrombolysis in myocardial infarction (TIMI) frame count. Fifty-one patients with absence of slow flow were selected as the control group. The angulations of the main coronary arteries with the aorta were measured from the axial images obtained through MDCT coronary angiography, and the findings were recorded. In addition, the coronary artery walls of these patients were evaluated. For statistical analysis, SPSS for Windows 10.0 (SPSS Inc., Chicago, IL) was used. For comparisons of the angles, either independent samples t test or the Mann-Whitney U test was used where appropriate. Results: The results of the study indicated that 38 patients had SCF in the LAD. Comparisons of patients with SCF with the controls revealed that in the patients with SCF, the mean angle of the LMCA with the aorta (40.9 +/- 20.5 degrees) was statistically significantly smaller than the mean angle of the LMCA with the aorta in the control cases (71.8 +/- 11 degrees). In 12 patients, slow flow was detected in the RCA. Those with slow flow in the RCA had significantly smaller angles (mean: 33.2 +/- 20.4 degrees) than the other cases (mean: 78.9 +/- 10.7 degrees). Conclusion: A small angle of origin of the main coronary arteries from the aorta, measured on MDCT examinations is correlated with slow blood flow in those vessels, as calculated by the TIMI frame count in catheter coronary angiography. Published by Elsevier Ireland Ltd

Türkiye’de 13, üçüncü basamak hastanenin katıldığı çok merkezli enfektif endokardit çalışması

Amaç: Bu çok merkezli geriye dönük çalışmada Türkiye’de infektif endokarditin klinik ve mikrobiyolojik özellikleri, ekokardiyografik bulguları ve tedavi stratejisinin belirlenmesi amaçlanmıştır. Yöntemler: Çalışmaya alınan grup 2005-2012 tarihleri arasında Türkiye’de 13 merkezde infektif endokardit tedavisi alan, retrospektif olarak 248 hastayı içermektedir. Tüm merkezler çevre hastanelerden hasta kabul eden üçüncü basamak hastaneler idi. Veriler, modifiye Duke kriterlerine göre infektif endokardit tanısı ile yatırılan hastaların arşiv bilgilerinden alınmıştır. Bulgular: Hastaların yüz otuz yedisi erkek idi. Hastalardan yüz elli sekizinde doğal kapak, yetmiş beşinde protez kapak endokarditi mevcuttu. İki yüz yirmi üç hastada (%89) vejetasyon mevcuttu ve 52 hastada vejetasyon birden fazla sayıda idi. Vejetasyon en sık mitral kapak (%43) konumunda bulundu. En sık görülen kapak hastalığı mitral yetersizliğiydi. En sık izlenen predispozan faktör romatizmal kapak hastalığı idi (%28). Pozitif kan kül- türü %65 oranında saptandı. En sık izole edilen sorumlu organizma Staphylococcus aureus idi (%29). Hastane içi ölüm hızı %33 olarak bulundu. Sonuç: Batılı ülkelerle karşılaştırıldığında ülkemizde infektif endokardit epidemiyolojisinin en önemli farklılıkları genç yaş, yüksek romatizmal kalp hastalığı prevelansı, sık enterokokal enfeksiyon ve yüksek kültür negatif sıklığıdır.Objective: The aim of this retrospective multicenter study was to investigate the clinical manifestations, microbiological profile, echocardio- graphic findings and management strategies of infective endocarditis (IE) in Turkey. Methods: The study population consisted of 248 Turkish patients with IE treated at 13 major hospitals in Turkey from 2005 to 2012 retrospec- tively. All hospitals are tertiary referral centers, which receive patients from surrounding hospitals. Data were collected from the medical files of all patients hospitalized with IE diagnosed according to modified Duke Criteria. Results: One hundred thirty seven of the patients were males. Native valves were involved in 158 patients while in 75 participants there was prosthetic valve endocarditis. Vegetations were detected in 223 patients (89%) and 52 patients had multiple vegetations. Mitral valve was the most common site of vegetation (43%). The most common valvular pathology was mitral regurgitation. The most common predisposing factor was rheumatic valvular disease (28%). Positive culture rate was 65%. Staphylococci were the most frequent causative microorganisms iso- lated (29%) followed by enterococci (11%). In-hospital mortality rate was 33%. Conclusions: Compared to IE in developed countries younger age, higher prevalence of rheumatic heart disease, more frequent enterococci infection and higher rates of culture negativity were other important aspects of IE epidemiology in Turkey

Arterial bending angle and wall morphology correlate with slow coronary flow: Determination with multidetector CT coronary angiography

Background and purpose: The purpose of this study was to assess angulations and vessel wall morphology that could lead to bending head loss in the RCA and LMCA arteries of patients with slow coronary flow (SCF) evaluated by MDCT coronary angiography