Patient compliance with postoperative analgesia after day case surgery: a multisite observational study of patients in North East London

Abstract

Background: Pain is the commonest reason for delayed discharge and readmission post day surgery with up to 45% of patients reported to suffer moderate-to-severe post-surgical pain 24 hours after discharge. The importance of post-surgical pain management extends beyond the acute phase when one considers that all chronic post-surgical pain was once acute. Although much focus is given to perioperative analgesia, a patient's pain management once discharged can be overlooked, whilst at this time the patient's pain management is within their own hands.

Methods: We conducted this multisite observational study of adult patients undergoing day case surgery. After obtaining patient consent data was collected on the operation, intra- and postoperative analgesia administered and discharge analgesia prescribed. Patients were then contacted at home by telephone 48 hours after discharge and asked about their postoperative pain and analgesia requirements.

Results: Of 150 patients consented for the enrolment, we were able to obtain postoperative analgesia data on 100. A total of 68% of patients reported pain following discharge with 26% reporting severe pain, defined as a pain score of ⩾7. A total 68% of patients were prescribed and dispensed analgesia, and of those, 83% were compliant with their analgesia. Thus, we conclude that in this patient group, the incidence of postoperative pain was not due to lack of patient compliance, but inadequate analgesia prescription.

Discussion: We recognise that our data reflect a patient population in North East London but suggest that the results may still be relevant to a wider patient group across the United Kingdom as the incidence of postoperative pain in our study was similar to published figures. Better patient satisfaction with postoperative analgesia may be obtained with more patient- and surgery-specific analgesic prescription.

Keywords: Acute pain; adult; day case surgery; pain; patient compliance; postoperative; postoperative analgesia.

Figure 1.

Distribution of patients by surgical specialty.

Figure 2.

Flow diagram of patients included.

Figure 3.

Maximum pain scores reported by patients in the 48 hours post surgery (n = 100).

Figure 4.

Prescription of discharge analgesia (n = 100).

Figure 5.

Pain score in relation to analgesia prescription. (a) of the 68% prescribed and dispensed analgesia, (b) of the 6% not dispensed analgesia and (c) of the 26% not prescribed analgesia.