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

Knowledge, Prevalence and Practice of Polycystic Ovary Syndrome among Sudanese women in Khartoum State, Sudan: The need for health education

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder and cause of infertility in women of reproductive age. Knowledge of females about health problems is considered an important factor that promotes females’ health-seeking behavior. This study aimed to evaluate females’ knowledge and attitude toward PCOS as well as to assess PCOS prevalence among the participants. Methods: A total of 240 females were included in the study between January and April 2019. A convenience sampling technique was used to select the participants. Data were collected using a self-administered questionnaire and analyzed using the Statistical Package for Social Sciences (SPSS) version 24. The analysis included frequencies of discrete variables and descriptors and cross-tabulation of the variables using the Chi-square test and logistic regression analysis. P < 0.05 was considered statistically significant. Results: The results showed a low level of knowledge (scoring <9) in 41.3%, a good level (scoring between 9 and 15) in 21.3%, and also an excellent level of knowledge (scoring >15) in 37.5%. The Chi-square statistical test showed significant associations between the level of knowledge and education level, urban residence, health profession, marital status, and the prevalence of PCOS (p < 0.001, <0.001, <0.001, 0.045, and <0.001), respectively. Logistic regression showed that the females’ knowledge about PCOS was significantly associated with urban residence and being a health professional (p = 0.004 and p < 0.001, respectively). Conclusion: The study highlighted that there was inadequate knowledge about the disease among participants and showed an urgent need to improve the knowledge about PCOS among Sudanese women