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

Levels of fibrinogen, high sensitive C-reactive protein and lipid parameters as a cardiovascular risk factor in subclinical hypothyroid patients

Amaç: Subklinik hipotiroidi hafif orta tiroid yetmezlik durumudur. Kardiyovasküler risk artışı ile ilişkili bir durumdur. Dislipidemi ve koagülasyonla ilgili parametrelerdeki değişiklikler subklinik hipotiroidide potansiyel olarak ateroskleroz gelişiminden sorumlu olabilir. Bu çalışmada, subklinik hipotiroidili hastalar ile kontrol grubu arasında kardiyovasküler risk faktörü olarak fibrinojen, yüksek duyarlılıklı C-reaktif Protein ve lipid parametreleri bakımından fark olup olmadığını araştırmayı amaçladık.Gereç ve Yöntemler: Yeni tanı almış 44 subklinik hipotiroidili hasta ve kontrol grubu olarak ise bilinen herhangi bir hastalığı olmayan sağlıklı 44 kişi çalışmaya alındı. Sigara ve alkol kullananlar çalışmaya dahil edilmedi. Serbest tiroid hormonları normal sınırlarda iken serum TSH değerinin 4 mIU/L'den büyük olması subklinik hipotiroidi olarak tanımlandı. Vaka ve kontrol grubu fibrinojen, yüksek duyarlılıklı C-reaktif Protein ve lipid parametreleri bakımından birbiriyle karşılaştırıldı.Bulgular: Vaka grubunda fibrinojen, yüksek duyarlılıklı C-reaktif Protein ve total kolesterol düzeyi kontrol grubuna göre istatistiksel anlamlı olarak daha yüksek saptandı (p<0,001, p<0,001, p=0,042, sırasıyla). Vaka grubunda ortalama TSH düzeyi 6,3 mIU/L olup TSH düzeyine göre alt gruplar incelendiğinde fibrinojen, yüksek duyarlılıklı C-reaktif Protein ve total kolesterol bakımından TSH değeri 6-10 mIU/L arasında olan grupla 10 mIU/L 'dan büyük olan grup arasında anlamlı fark izlenmedi (p=0,283, p= 0,140, p=0,283, sırasıyla).Sonuçlar: Bu çalışmanın sonuçları fibrinojen, yüksek duyarlılıklı C-reaktif Protein ve total kolesterol düzeylerinin subklinik hipotiroidili hasta grubunda kontrol grubuna göre anlamlı oranda yüksek olduğunu gösterdi. Bu faktörler, subklinik hipotiroidi varlığında artmış ateroskleroz riskine katkıda bulunabilirAim: Subclinical hypothyroidism is defined as mild thyroid failure and it is associated with an increase in cardiovascular risk. The changes in the parameters related to dyslipidemia and coagulation may potentially contribute to the development of atherosclerosis in subclinical hypothyroidism. In this study, we aimed to investigate the difference between the subclinical hypothyroid patients and the control group in terms of fibrinogen, high sensitive C-reactive protein and lipid parameters as a cardiovascular risk factor. Material and Methods: The participants of this study were 44 newly-diagnosed subclinical hypothyroid patients. The control group was composed of 44 healthy subjects with no specific disease. Smokers and alcohol consumers were not included in the study. Serum TSH level greater than 4 mIU/L was defined as subclinical hypothyroidism while free thyroid hormones within normal limits. The patient and the control group were compared in terms of fibrinogen, high sensitive C-reactive protein and lipid parameters. Results: Fibrinogen, high sensitive C-reactive protein and total cholestrol levels in the patient group were found statistically higher than those of the control group (P < 0.001, P < 0.001, P = 0.042, respectively). The average TSH level was 6.3 mIU/L in the patient group. When the sub-groups were examined according to their TSH levels in terms of fibrinogen, high sensitive CRP and total cholestrol, we observed no statistically significant difference between the group with TSH level between 6-10 mIU/L and the group with TSH level higher than 10 mIU/L (P = 0.283, P = 0.140, P = 0.283, respectively).Conclusion: The results of this study showed that, in the subclinical hypothyroid patients fibrinogen, high sensitive C-reactive protein and total cholesterol levels were statistically higher than those of the control group. These factors may contribute to increased atherosclerosis in subclinical hypothyroidis