BJA open最新文献

{"title":"Environmental harm from anaesthesia: the importance of clinical realism and chemical persistence: a reply","authors":"Sarah-Louise Watson , Tom E.F. Abbott","doi":"10.1016/j.bjao.2025.100495","DOIUrl":"10.1016/j.bjao.2025.100495","url":null,"abstract":"","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100495"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between preoperative anxiety and chronic post-surgical pain after general anaesthesia, a systematic review and meta-analysis","authors":"Mirjam Bakker-Bons ,&nbsp;Ria M.J. Hijmering ,&nbsp;Remko Soer ,&nbsp;André P. Wolff","doi":"10.1016/j.bjao.2025.100487","DOIUrl":"10.1016/j.bjao.2025.100487","url":null,"abstract":"<div><h3>Background</h3><div>Chronic post-surgical pain (CPSP) is a burden for both patients and healthcare, yet current treatment options are insufficient. Previous studies indicate preoperative anxiety as a risk factor for developing CPSP, yet no high-quality review exists. This study aims to systematically review the relationship between increased preoperative anxiety and the incidence of new CPSP.</div></div><div><h3>Methods</h3><div>Four databases were used to identify relevant studies for a systematic review and meta-analysis. Inclusion criteria included adult patients undergoing surgical procedures under general anaesthesia, measuring preoperative anxiety with validated tools, and postoperative pain at least 3 months after surgery. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed, and a risk of bias analysis was performed.</div></div><div><h3>Results</h3><div>Of the 233 studies retrieved, 26 studies were included in the systematic review. Following risk of bias analysis, 23 papers were included in the meta-analysis. A correlation was found between preoperative anxiety and CPSP, with a standardised mean difference of 0.31 (95% confidence interval 0.20–0.41). High heterogeneity was observed, which was attributed to several possible confounding factors. Subgroup analysis did not alter this outcome. When translating the outcome to a relevant scale, we observed an increase in numeric rating scale pain of 0.34 for patients experiencing preoperative anxiety.</div></div><div><h3>Conclusions</h3><div>There is moderate-quality evidence indicating a positive association between preoperative anxiety and CPSP, where an increase in preoperative anxiety correlates with an increased incidence of CPSP. More research is needed to identify specific patients that would benefit from treating preoperative anxiety and thus potentially preventing CPSP.</div></div><div><h3>Systematic review protocol</h3><div>PROSPERO (CRD42024513479).</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100487"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145268331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Adolescent Surgery Experience (ASE): a survey-based prospective cohort study to measure risk factors for persistent opioid use","authors":"Tori N. Sutherland ,&nbsp;Scott E. Hadland ,&nbsp;Jiwon Moon ,&nbsp;Joana Fardad ,&nbsp;Elizabeth Ramsay ,&nbsp;Michael J. Kallan ,&nbsp;Mark D. Neuman","doi":"10.1016/j.bjao.2025.100496","DOIUrl":"10.1016/j.bjao.2025.100496","url":null,"abstract":"<div><h3>Background</h3><div>Increasing data suggest adolescents have elevated risk of persistent postsurgical pain and opioid use, but their recovery experience remains poorly characterised.</div></div><div><h3>Methods</h3><div>This prospective cohort study enrolled opioid-naive adolescents without chronic pain between June 2022 and May 2023 before undergoing procedures with anticipated mild, moderate, or severe postoperative pain. Participants completed eight surveys during recovery. We measured characteristics associated with persistent opioid use, including non-surgical site pain, difficulty sleeping, depression (Patient Health Questionnaire-9 [PHQ-9]), and anxiety (General Anxiety Disorder [GAD-7]) over 5 months after surgery.</div></div><div><h3>Results</h3><div>Five hundred adolescents (median age: 15 yr (inter-quartile range 13–17 yr]) completed the baseline survey. Overall, 47.4% were female, 69.6% identified as White, 22.4% as Black/African American, and 10.8% as Hispanic/Latino. Overall, one in five (21.1%) reported depression, approximately two in five reported anxiety (37.4%), and one in six (16.6%) reported prior-year substance use. Among those undergoing procedures associated with severe pain, 93.4% received an outpatient opioid prescription (median 18 doses [inter-quartile range 12–25 doses]). At the end of the study, 16.7% (<em>n</em>=47) reported regular non-surgical site pain, 20.6% (<em>n</em>=58) had difficulty sleeping, and 15.7% and 15.3% had persistent depression and anxiety symptoms, respectively.</div></div><div><h3>Conclusion</h3><div>A high proportion of adolescents endorsed preoperative anxiety, depression, and substance use, which, in combination with prescription opioids, are known risk factors for postoperative opioid use disorder. Over time, postoperative non-surgical site pain, difficulty sleeping, depression, and anxiety declined but remained common. Additional research is needed to understand the relationship between pre- and postoperative risk factors and adverse outcomes during surgical recovery.</div></div><div><h3>Clinical trial registration</h3><div>NCT05482919.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100496"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining reduced functional capacity in older adults using research-grade wearable accelerometers: a secondary analysis of the study of muscle, mobility, and aging","authors":"Anthony Hung ,&nbsp;Nancy W. Glynn ,&nbsp;Reagan E. Garcia ,&nbsp;Megan Hetherington-Rauth ,&nbsp;Peggy M. Cawthon ,&nbsp;Daniel E. Forman ,&nbsp;Eileen Johnson ,&nbsp;Daniel S. Rubin","doi":"10.1016/j.bjao.2025.100510","DOIUrl":"10.1016/j.bjao.2025.100510","url":null,"abstract":"<div><h3>Background</h3><div>Reduced functional capacity (FC) is associated with adverse surgical outcomes in older adults. Current FC assessments rely on questionnaires; however, it remains unclear whether accelerometer-measured daily activity provides a more accurate evaluation. Our primary aim was to identify accelerometer-based variables associated with reduced FC.</div></div><div><h3>Methods</h3><div>We conducted a secondary analysis of the Study of Muscle, Mobility and Aging (SOMMA) cohort. Participants were community-dwelling adults (non-surgical) aged ≥70 yr and recruited between the years 2019 to 2021 at the University of Pittsburgh (Pittsburgh, PA, USA) and Wake Forest University School of Medicine (Winston-Salem, NC, USA). Participants were included if they completed cardiopulmonary exercise testing and had valid wear time (≥3 days) for two accelerometers used in the SOMMA study (ActiGraph GT9X and activPAL4). We applied classification and regression tree and random forest models to accelerometry-derived metrics. For comparison, we constructed a logistic regression model using modified Duke Activity Status Index 4-Question (M-DASI-4Q) scores extrapolated from the Community Healthy Activities Model Program for Seniors questionnaire.</div></div><div><h3>Results</h3><div>The final cohort included 640 participants (57.2% [366/640] women; mean age 76.3 [5.0] yr), of whom 18% (114/640) had reduced FC (peak oxygen uptake [VO₂peak] &lt;16 ml kg⁻¹ min⁻¹). Participants with adequate FC had higher daily step counts (5843.9 [2950.4] <em>vs</em> 2988.3 [1757.2] steps per day; <em>P</em>&lt;0.001) and more time in moderate-to-vigorous physical activity (118.0 [62.2] <em>vs</em> 59.9 [42.4] min day⁻¹; <em>P</em>&lt;0.001) compared with those with reduced FC. The accelerometer-based random forest model (AUC 0.79) did not significantly outperform the M-DASI-4Q model (AUC 0.72; <em>P</em>=0.16).</div></div><div><h3>Conclusion</h3><div>Among community-dwelling older adults, daily step count and time in moderate-to-vigorous activity were most associated with FC, but the accelerometer-based model showed only fair discrimination to identify participants with reduced FC. Validation in surgical populations is needed.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100510"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney disease and cardiac surgery: marker, mediator, or both?","authors":"Abraham H. Hulst ,&nbsp;Fabrizio Monaco","doi":"10.1016/j.bjao.2025.100507","DOIUrl":"10.1016/j.bjao.2025.100507","url":null,"abstract":"<div><div>Cardiac surgery places an enormous burden on the kidneys, and therefore, acute kidney injury (AKI) is a common postoperative complication. Pre-existing chronic kidney disease (CKD) is a strong predictor of cardiac surgery-associated AKI, in addition to the evidence of a bidirectional interaction where AKI also accelerates the progression of CKD and increases the risk of renal failure. While observational research links kidney dysfunction to prolonged hospital stays, morbidity, and mortality, the question remains whether AKI is a modifiable mediator or merely a perioperative risk predictor. Larger analyses, including that of Bille and colleagues, indicate that AKI drives the acceleration of CKD. These findings provide further evidence for systematic follow-up and early implementation of kidney-protective measures to optimise long-term renal function after cardiac surgery.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100507"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145746877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"North American and European practices for opioid-sparing and opioid-free anaesthesia: a cross-sectional survey","authors":"Yann Gricourt ,&nbsp;Nancy M. Boulos ,&nbsp;Yann Daoulas ,&nbsp;Tristan Grogan ,&nbsp;Brenton Alexander ,&nbsp;Myriam Mezzarobba ,&nbsp;Philippe Cuvillon ,&nbsp;Esther M. Pogatzki-Zahn ,&nbsp;Helene Beloeil ,&nbsp;Maxime Cannesson ,&nbsp;Patrice Forget ,&nbsp;Alexandre Joosten","doi":"10.1016/j.bjao.2025.100511","DOIUrl":"10.1016/j.bjao.2025.100511","url":null,"abstract":"<div><h3>Background</h3><div>Opioids remain central to perioperative analgesia but concerns about the growing opioid crisis and adverse effects have prompted revaluation of their role. Opioid-sparing anaesthesia and opioid-free anaesthesia (OFA) have emerged as alternatives, yet their clinical adoption remains uncertain. This survey assessed adoption and perceptions among anaesthesiologists in North America and Europe.</div></div><div><h3>Methods</h3><div>A 26-question cross-sectional, web-based survey was distributed via email to members of the American, European, and French Societies of anaesthesiologists. The survey assessed routine use of opioid-sparing techniques, defined as the regular use of non-opioid analgesics and adjuncts to minimise intraoperative opioid use in the past month. We hypothesised that fewer than 50% of anaesthesiologists routinely used these techniques during this period.</div></div><div><h3>Results</h3><div>The overall response rate was 2% among ASA members (614/31 000) and 12% among European Society of Anaesthesiology and Intensive Care (ESAIC) members (414/3500). Concern about opioid use was reported as high in ESAIC and ASA members (90% <em>vs</em> 83%, <em>P</em>&lt;0.001). Daily use of opioid sparing techniques was reported by 37% (95% confidence interval [CI] 32–42%) of ESAIC and 40% (95% CI 36–45%) of ASA members. OFA use was less common overall but reported to be higher by ASA repondents (21%, 95% CI 18–25%) <em>vs</em> 12% (95% CI 9–15%), <em>P</em>&lt;0.001) for EASIC respondents. Perceived risks differed: EASIC respondents more often cited haemodynamic instability (43% <em>vs</em> 16%, <em>P</em>&lt;0.001), whereas ASA respondents more often cited patient dissatisfaction (55% <em>vs</em> 30%) and uncontrolled pain (72% <em>vs</em> 53%, both <em>P</em>&lt;0.001). Key barriers to OFA adoption included limited training, low confidence, and lack of evidence-based guidelines.</div></div><div><h3>Conclusions</h3><div>Interest in opioid-sparing anaesthesia and OFA is widespread, but routine use remains modest and varies by region. Regional perceptions, institutional protocols, and confidence in evidence appear to influence implementation.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100511"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Paediatric surgical volume and associated mortality in England: a nationwide study over an eight year period","authors":"Juri Althonayan ,&nbsp;Alexander J. Fowler ,&nbsp;Benjamin Allin ,&nbsp;Amaki Sogbodjor ,&nbsp;Timothy Bradnock ,&nbsp;Nara Orban ,&nbsp;Thomas D. Dobbs ,&nbsp;Marian Knight ,&nbsp;Rupert M. Pearse ,&nbsp;Tom E.F. Abbott","doi":"10.1016/j.bjao.2025.100505","DOIUrl":"10.1016/j.bjao.2025.100505","url":null,"abstract":"<div><h3>Background</h3><div>Reports on delays to National Health Service (NHS) surgical care have been widespread during and after the pandemic, however the impact on paediatric surgery is poorly described.</div></div><div><h3>Methods</h3><div>This retrospective observational cohort study used NHS hospital data in England for children aged &lt;18 yr undergoing surgery over an 8-yr period from 1 April 2015 to 31 December 2020, with supplementary data until March 2023. The primary outcome was in-hospital mortality within 90 days after surgery. The secondary outcome was hospital stay. We report trends in annual surgical procedure volume and mortality. Frequencies presented as <em>n</em> (%).</div></div><div><h3>Results</h3><div>We identified 36 605 870 surgical procedures, between 1 April 2015 and 31 December 2020, of which 1 846 965 (5.0%) were for children. A total of 759 083/1 846 965 (41.1%) patients were female and 313 981 (17.0%) were from minority ethnic groups. There were 41 018/1 846 965 (2.2%) procedures among neonates, 93 872 (5.1%) for children aged 28 days to 1 yr, 532 828 (28.8%) for years 1–5, 502 971 (27.2%) for years 5–12, 361 176 (19.6%) for years 12–15, and 315 100 (17.1%) for years 15–17. Median hospital stay was 1 (0–1) day. There were 6 573/1 846 965 (0.36%) in-hospital deaths within 90 days after surgery, and a trend for increasing mortality risk between 2015 and 2020 (<em>P</em>&lt;0.05). The average annual number of procedures before the pandemic (2015–19) was 340 596, decreasing to 266 049 in 2023 (22% reduction in volume).</div></div><div><h3>Conclusions</h3><div>We report the trends in paediatric surgical volume and assocaited mortality for an entire healthcare system over eight years inlcuding during the COVID-19 pandemic. One in 14 surgical procedures were performed on children, with substantially lower mortality risk than adults.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100505"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145624010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erector Spinae Plane block with fascial plane catheter for the Early Analgesia of Rib fractures in trauma (ESPEAR): a multicentre feasibility randomised trial","authors":"David W. Hewson ,&nbsp;Jessica Nightingale ,&nbsp;Reuben Ogollah ,&nbsp;Adam Brooks ,&nbsp;Lauren Blackburn ,&nbsp;Benjamin J. Ollivere ,&nbsp;Matthew L. Costa ,&nbsp;Tim Egan ,&nbsp;Peter Bates ,&nbsp;Ian Tyrrell-Marsh ,&nbsp;Nigel M. Bedforth","doi":"10.1016/j.bjao.2025.100498","DOIUrl":"10.1016/j.bjao.2025.100498","url":null,"abstract":"<div><h3>Background</h3><div>Traumatic rib fractures cause significant acute pain. Patients are at risk of hypoventilation, atelectasis, hypoxia, retained secretions, pneumonia, respiratory failure, and death. Effective analgesia is thought to reduce these adverse outcomes. There is widespread variation in analgesic treatments given to patients including oral, intravenous, and epidural routes of administration. Erector spinae plane (ESP) block, a novel regional analgesic technique, may be effective, but high-quality evidence is lacking.</div></div><div><h3>Methods</h3><div>To determine if a definitive trial of ESP block and catheter in rib fractures is possible, we conducted a multicentre, randomised, controlled pilot study with feasibility assessment. Adults with rib fractures were randomised in a 1:1 ratio to either (i) ESP blockade and catheter, or (ii) placebo ESP blockade and catheter, both for 72 h. In addition, all participants received multimodal analgesia. Participants and outcome assessors were blinded. The primary feasibility outcomes were recruitment rate (target: ≥1.11 participants/site/month), retention rate (target: ≥80%), and trial acceptability assessed by staff interview. Pre-specified red–amber–green criteria were agreed to determine feasibility of a future definitive clinical trial on this topic.</div></div><div><h3>Results</h3><div>Twenty-five participants (mean [standard deviation] age 57 [16] yr, number of rib fractures 5 [3]) were recruited from three UK major trauma centres at a rate of 0.69 participants per site per month. Retention to 6-week follow-up was 80%. Based on our criteria, the current study design is not feasible for adoption into a definitive trial. For future research in this area, we recommend substantial modification to (i) the intervention, (ii) means of bias reduction, and (iii) timing and nature of outcome measure assessments.</div></div><div><h3>Conclusions</h3><div>Based on pre-specified criteria, a definitive examination of the clinical effectiveness of ESP block in the analgesic management of adults after blunt force chest wall injury is only feasible if substantial amendments to trial processes piloted in this study are undertaken. An open-label assessment of single-shot ESP block, applying patient-reported average pain intensity of the first 24 h as the primary outcome, and conducted at sites with established ESP analgesic pathways, may overcome the most significant feasibility barriers identified by the present study.</div></div><div><h3>Clinical trial registration</h3><div>ISRCTN49307616.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100498"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterisation and evaluation of early mobilisation interventions after emergency laparotomy surgery: a scoping review","authors":"Leonie Murphy ,&nbsp;Todd Leckie ,&nbsp;Stefanie Harding ,&nbsp;Ana-Carolina Gonçalves ,&nbsp;Luke Hodgson","doi":"10.1016/j.bjao.2025.100501","DOIUrl":"10.1016/j.bjao.2025.100501","url":null,"abstract":"<div><div>Emergency laparotomy is a high-risk surgery, and postoperative functional decline contributes to the 1-yr mortality of 25%. However, there is no established guidance around postoperative interventions to restore functional capacity, including early mobilisation. This scoping review synthesised current evidence on the definition of early mobilisation, delivery of interventions, barriers, and outcomes reported for postoperative mobilisation interventions.</div><div>The review followed a structured methodological framework and was registered with Open Science Framework. Studies were identified through MEDLINE, Embase, and CINAHL. Eligible studies described an early mobilisation protocol (in isolation or as a bundled intervention) after emergency laparotomy. Data were extracted and analysed descriptively.</div><div>Fourteen studies (2783 participants) were included, with all but one published since 2018. Mobilisation out of bed within 24 h of surgery was the most frequently used definition of early mobilisation. Adherence rates ranged from 31% to 96%. Interventions were heterogeneous, ranging from encouragement to achieve mobilisation targets through to comprehensive multidisciplinary programmes. Intervention groups tended to achieve earlier and greater mobilisation. Key modifiable barriers were pain, fatigue, and limited physiotherapy staffing. All studies reported physical performance outcomes; only one reported quality of life outcomes.</div><div>This scoping review found heterogeneity in the delivery, dose, timing, and adherence to mobility interventions. Barriers to mobilisation after emergency laparotomy mirror those described after elective surgery. We suggest alignment in reporting the impact of individual factors (such as frailty and socioeconomic context) and core outcomes (including patient-centred measures) to standardise early postoperative mobilisation interventions and allow for synthesis of the evidence base.</div></div><div><h3>Scoping review protocol</h3><div>Open Science Framework (https://doi.org/10.17605/OSF.IO/R63CP).</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100501"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145417565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"New persistent opioid use after surgery and traumatic injury: a narrative review of global rates, risk factors, and healthcare interventions","authors":"Thuy Bui ,&nbsp;Michael J. Dooley ,&nbsp;J. Simon Bell ,&nbsp;Paul S. Myles","doi":"10.1016/j.bjao.2025.100509","DOIUrl":"10.1016/j.bjao.2025.100509","url":null,"abstract":"<div><div>Up to one-third of patients are discharged with opioids after surgery, and up to one-half after traumatic injury, with usage typically intended for the short term. Evidence on persistent opioid use predominantly originates from North America, particularly the USA, and focuses on the elective surgical population. Definitions of new persistent opioid use vary widely, particularly in how opioid-naïve patients are classified and continued use is measured. The reported incidence of new persistent opioid use after surgery and trauma ranges from &lt;1% to 41%, depending on the population, setting, and definition used. Although patient characteristics and factors related to surgery and trauma care are key risk factors, many of which are not readily modifiable, opioid prescribing practices represent a modifiable and actionable target for intervention. Understanding these risks can assist healthcare providers in implementing alternative management strategies to promote judicious opioid prescribing and reduce persistent opioid use. High-income countries with substantial opioid-related harms have implemented various strategies, ranging from national to hospital-level initiatives, to reduce prescribing and limit opioid exposure after hospital discharge. A priority is the development and adoption of standardised definitions, which consider the various opioid medications, incorporate different data sources, and clearly define thresholds for duration and quantity of use. Further research on new persistent opioid use in more regions, after trauma, targeted interventions, and their impact on patient-centred outcomes is needed.</div></div>","PeriodicalId":72418,"journal":{"name":"BJA open","volume":"16 ","pages":"Article 100509"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145694170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}