Introduction
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.
Methods
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.
Results
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.
Discussion
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.
Plain Language Summary
What we did
Researchers studied 7839 adults who had day-case surgery in the UK. They asked patients about their pain, ability to do normal activities and overall recovery on the first, third and seventh days after surgery. They wanted to understand how quickly people recovered during the first week.
Why did we do it
More and more operations are done as day cases, with patients going home on the same day. However, we do not know enough about what happens to patients once they leave hospital. The researchers wanted to find out how much pain people have during the first week and whether pain stops them from doing normal activities.
What we found
Pain usually became less severe during the first week, but many people had not fully recovered by day seven. About one in three patients had a poor pain outcome during the first week, and about one in four still found that pain stopped them doing normal activities on day seven. People with long-term pain, frailty, anxiety or depression, or those having bigger operations were more likely to have problems. Some types of surgery, such as head and neck or orthopaedic surgery, were also linked with poorer recovery. These findings suggest that some patients may need better preparation before day-case surgery and more support after they go home.