Highlights
- •Postoperative outcomes in Spanish hospitals were obtained using a multidimensional scale.
- •Spanish pain outcomes were similar to those reported in Europe and the United States.
- •Patient's participation in pain management was poor.
- •Presurgical chronic pain (numeric rating scale score >7) was associated with worsened pain outcomes.
- •Adequate control of chronic pain might improve postoperative outcomes.
Abstract
Pain after surgery remains a problem worldwide, although there are no published data
on postoperative outcomes in Spain. We evaluated 2,922 patients on the first day after
surgery in 13 tertiary care Spanish hospitals, using the PAIN-OUT questionnaire. The
aims were to: assess postoperative outcomes and anesthetic/analgesic management in
Orthopedics (ORT) and General Surgery (GEN) patients; explore the influence of the
analgesic therapy on outcomes and opioid requirements; evaluate and compare outcomes
and analgesic management according to surgical procedure. Mean worst pain and percentage
of patients in severe pain were 5.6 (on a numeric rating scale of 0–10) and 39.4%,
respectively, slightly lower than those reported in Western countries (range, 5.0–8.4
and 33–55%). Patients’ pain assessment (83.1%) and information were high (63.3%),
but participation in decision-making (4.8) was lower than in the United States (7.0)
and Europe (Germany, France, Norway, and Denmark; mean, 5.9). Patients after orthopedic
surgery had the worst outcomes. General anesthesia was more frequent in GEN patients,
whereas regional (central and peripheral) was more frequent in ORT surgery patients.
Mean opioid consumption (20.2 mg per patient per 24 hours, oral morphine equivalents),
was lower than reported and decreased >50% after regional analgesia. Intravenous morphine
patient-controlled analgesia was seldom used (6.2%). Acute opioid treatments were
associated with worsened outcomes whereas multimodal analgesia (mainly antipyretic
analgesics–nonsteroidal anti-inflammatory drugs–opioids) were associated with improved
results. Epidurals in abdominal surgery (16.7%) were also associated with better outcomes.
Presurgical chronic pain (>7) and/or chronic opioid consumption, were associated with
worsened pain outcomes; the latter with a 50% increase in postoperative opioid requirements.
Tibia/fibula and foot surgeries (ORT), and gastric, small intestine, and anterior
abdominal wall procedures (GEN) were the most painful. Rigorous control of chronic
pain before surgery, and combining opioids with adjuvants and other analgesics perioperatively,
might improve postoperative outcomes.
Perspective
We analyzed postoperative outcomes and analgesic management in patients from tertiary
care Spanish hospitals. The study serves as a point of comparison with other Western
countries and shows that pain intensity outcomes and opioid consumption were slightly
better in the Spanish population. Chronic pain before surgery (numeric rating scale
score >7) and/or chronic opioid consumption, were associated with worsened pain outcomes,
suggesting that rigorous control of chronic pain before surgery, and combining opioids
with adjuvants and other analgesics perioperatively, might improve outcomes. Patients’
pain participation in decision-making was inadequate and should be improved in Spanish
hospitals.
Key words
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Article info
Publication history
Published online: June 14, 2017
Accepted:
May 31,
2017
Received:
April 28,
2017
Footnotes
Current address for Mauricio Polanco-García, MD, Department of Anesthesiology Hospital Comarcal de l’Alt Penedès, Barcelona, Spain.
This work was funded by the 7th framework program of the European Union. Grant Agreement No. 223590, and the Endowed Chair in Pain Management, Universitat Autònoma de Barcelona-Parc de Salut Mar-Menarini (M.M.P.).
W.M. discloses receipt of grants/research support from Pfizer; receipt of honoraria or consultation fees from AcelRx Pharmaceuticals, Menarini, BioQ, Pharma, Grünenthal, Medicines Company, Mundipharma, and participation in a company-sponsored speaker's bureau for Menarini, Grünenthal, Mundipharma, and BioQ, Pharma.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2017 Published by Elsevier Inc. on behalf of the American Pain Society
