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Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: A survey of 5,703 patients

Trente pour cent des patients ont des douleurs modérées à sévères, 24 h après la chirurgie ambulatoire : Une enquête auprès de 5 703 patients

  • General Anesthesia
  • Published:
Canadian Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Purpose

Postoperative pain is the commonest reason for delayed discharge and unanticipated hospital admission after ambulatory surgery. We investigated the severity of pain at 24 hr postoperatively and determined the most painful procedures. The need for further medical advice and clarity of postoperative analgesia instructions were also studied.

Methods

Five thousand seven hundred and three ambulatory surgical patients were telephoned 24 hr postoperatively. Patients graded their pain using the ten-point self-assessing verbal scale (0 = no pain, 10 = worst pain). Data were analyzed in two groups, those with moderate to severe pain (pain score 4–10) and those with no or mild pain (0–3).

Results

Thirty percent of patients (1,495/5,703) had moderate to severe pain. Microdiscectomy, laparoscopic cholecystectomy, shoulder surgery, elbow/hand surgery, ankle surgery, inguinal hernia repair, and knee surgery were identified as the procedures causing most pain at 24 hr. 13.2% of patients needed medical advice by telephone, 1.4% made an unplanned visit to a doctor while the rate of readmission to the hospital was 0.08%. Ninety-eight percent found postoperative instruction sheets and advice helpful. Eighty-eight percent of patients indicated that analgesic instructions were absolutely clear.

Conclusion

This study has identified the more painful common ambulatory surgical procedures which will allow take home analgesia to be tailored according to individual procedures. Further improvement in analgesic instructions may help in better pain management of ambulatory surgery patients.

Résumé

Objectif

La douleur postopératoire cause la plupart des départs retardés de l’hôpital ou des admissions non prévues après la chirurgie ambulatoire. Nous avons vérifié la sévérité de la douleur, 24 h après l’opération, et déterminé les interventions les plus douloureuses. La nécessité d’avis médical supplémentaire et la clarté des directives sur l’analgésie postopératoire ont aussi été notées.

Méthode

Nous avons téléphoné à 5 703 patients de chirurgie ambulatoire 24 h après l’opération. Les patients ont coté leur douleur selon une échelle verbale d’auto-évaluation en dix points (0 = aucune douleur, 10 = douleur très intense). Les données ont été classées en deux groupes : douleur modérée à sévère (score de 4–10) et douleur absente ou légère (0–3).

Résultats

Trente pour cent des patients (1 495/5 703) ont éprouvé des douleurs modérées à sévères. La microdiscectomie, la cholécystectomie laparoscopique, l’opération de l’épaule, du coude/de la main, de la cheville, la réparation d’une hernie inguinale et l’opération du genou causaient le plus de douleurs à 24 h. Nous avons noté que 13,2% des patients ont eu besoin d’avis médical au téléphone, 1,4% d’une visite médicale imprévue et 0,08 % d’une réadmission hospitalière. Les feuilles de directives postopératoires et les conseils ont été utiles pour 98 % des patients. Les directives sur l’analgésie ont été absolument claires pour 88 % des patients.

Conclusion

La présente étude a désigné les opérations chirurgicales ambulatoires courantes les plus douloureuses qui devront comporter une analgésie postopératoire à domicile adaptée aux besoins individuels. L’amélioration du traitement de la douleur postopératoire pourrait passer par des directives analgésiques plus claires.

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Authors and Affiliations

  1. Department of Anesthesia, University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada

    Brid McGrath, Hany Elgendy, Frances Chung, Damon Kamming, Bruna Curti & Shirley King

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  1. Brid McGrath
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  2. Hany Elgendy
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  3. Frances Chung
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  4. Damon Kamming
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  5. Bruna Curti
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  6. Shirley King
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Correspondence to Frances Chung.

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McGrath, B., Elgendy, H., Chung, F. et al. Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: A survey of 5,703 patients. Can J Anesth 51, 886–891 (2004). https://doi.org/10.1007/BF03018885

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