Patient-reported outcomes, postoperative pain and pain relief after day-case surgery (POPPY): acute pain and recovery during the first 7 days.

Abstract

The majority of surgical cases in the UK occur in a day-case setting. Published short-term follow-up studies after day-case surgery are lacking and patterns of recovery including pain and patient reported outcome measures, are largely unknown. Data from the Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study, a national, prospective, observational study exploring outcomes following day-case surgery in the UK, were used to explore acute recovery over the first 7 postoperative days. Baseline data were captured on the day of surgery alongside pain severity, functional scores and quality of recovery-15 scores on postoperative days 1, 3 and 7. A poor pain outcome was defined as a pain severity score of > 4/10 and a poor functional outcome was defined as any functional impairment due to pain on days 1, 3 and 7. Of the 7839 patients initially recruited, 7331 responded on day 7. Pain severity scores decreased over the first postoperative week and yet pain impaired function in 1279/4854 (26.3%) patients at day 7. In the first 7 days, 1458/4348 (33.5%) of patients had a poor pain outcome. Associated variables included: treatment for anxiety or depression; baseline chronic pain; frailty; greater surgical magnitude; and type of surgery (head and neck surgery). Increasing age was associated with reduced probability of poor pain outcomes. Poor functional outcomes were associated with: surgical magnitude; type of surgery (orthopaedic surgery); chronic pain; and frailty. Opioid naivety was associated with a reduced odds ratio of both poor pain and functional outcomes. These findings suggest that by postoperative day 7, recovery from day-case surgery is incomplete for many patients. We identified characteristics associated with poor pain and functional outcomes that could be used to improve peri-operative pathways, in particular highlighting patients who may benefit from enhanced preparation and closer follow up.