Anaesthesia最新文献

Introduction: Most patients undergoing elective surgery in the UK are discharged from hospital on the same day. Despite this, there is a lack of UK patient-centred outcome measures relating to quality of recovery, pain and analgesic use. The POPPY study was a UK-wide prospective, observational study measuring short- and longer-term patient-reported outcomes following day-case surgery. This article is the second in a series and describes baseline characteristics to contextualise successive articles which explore outcome data.

Methods: Baseline data were collected from eligible consenting adults undergoing day-case surgery. Data included patient characteristics; pre-operative analgesic use; pre-existing pain surgical and anaesthetic details; and quality of life scores. Descriptive analysis was performed to provide baseline characteristics of the study cohort.

Results: A total of 9618 patients were eligible on screening from 199 sites, with 7839 eligible following exclusions. Unplanned admission following surgery was the most common reason for exclusion, affecting 1131/9618 (11.8%) patients. Unplanned admission was more likely with increasing surgical magnitude, frailty and higher ASA physical status. Some common operations had admission rates of > 50%. Pain at the site of proposed surgery was reported by 3060/7839 (39%) patients and this was chronic pain in 2387/7839 (30.5%). Opioids were taken at least daily by 885/7839 (11.3%) patients, 1109/7839 (14.1%) were receiving treatment for depression and 1039/7839 (13.3%) were receiving treatment for anxiety. Anxiety or depression was rated as moderate or worse in 1002/7839 (12.8%) patients.

Discussion: In the UK, over a third of patients presenting for day-case surgery are in pain, which is mostly chronic in duration. One in four have access to opioid medications and a little over one in 10 are using opioids daily. More than one in 10 do not receive their planned surgery as a day-case and readmission rates for day-case surgery do not meet suggested targets.

Introduction: Day-case surgical activity is increasing in the UK yet there is a lack of data on the prevalence of chronic post-surgical pain in this population. This study uses data from the POPPY study to estimate the prevalence of chronic post-surgical pain after day-case surgery, its relationship with quality of life and also explores associated factors.

Methods: Data were collected from eligible consenting adults having day-case surgery in 199 sites across the UK. Baseline data were collected on the day of surgery, and patients were followed up by short message service-delivered questionnaires on day 1, day 3, day 7 and day 97. Chronic post-surgical pain was defined using pain severity scores at day 97. Multivariable logistic regression models were used to explore associations with chronic post-surgical pain.

Results: At day 97, 3442 patients had responded from a total of 7839 recruited. The estimated prevalence of chronic post-surgical pain was 7.2% (95%CI 6.4-8.1%). We found the following were associated with chronic post-surgical pain: week 1 pain scores; orthopaedic, breast and plastic surgical specialities; non-surgical site chronic pain at baseline; deprivation; and ethnicity. Patients with chronic post-surgical pain had a mean (SD) decrease of 0.137 (0.205) in health-related quality of life score compared with baseline.

Discussion: This is the first large UK multicentre, prospective observational study exploring chronic post-surgical pain after day-case surgery. Multivariable modelling highlighted several associated factors. Chronic post-surgical pain is common after day-case surgery and is associated with reduced quality of life.

Introduction: Gender equity for anaesthetists remains elusive, despite patient and clinician benefits. Many strategies have been proposed to promote gender equity, yet women remain under-represented in anaesthesia leadership compared with men. This review identifies contemporary implemented strategies to improve gender equity in anaesthesia leadership.

Methods: We searched databases for studies published from January 2019 to March 2024, including reports of implementation. We employed state-of-the-art review methodology to provide a current understanding of this complex sociocultural problem, using Cook's and Stufflebeam frameworks for categorisation and deductive data extraction and analysis based on context, inputs, processes and outcomes.

Results: We screened 257 abstracts and identified 18 studies for analysis; 14 were conducted in the USA. The most prominent individual interventions were mentorship and sponsorship. These were supported by organisational interventions including professional development curricula; policies; and leadership roles supporting diversity. Two studies reported how programmes were iteratively developed. Reported success metrics included quantitative (increased diversity in leadership, achieving promotion) and qualitative outcomes (networks and wellbeing).

Discussion: Evidence for best practices to address gender equity in anaesthesia leadership is emerging. Prospective determination of key outcomes enables monitoring of success, including representation and wellbeing. Organisational support, in the form of policies and leadership roles linked to diversity outcomes, amplifies the benefits of mentorship and sponsorship. Future interventions should report the context in which the interventions were mobilised, associated costs and details of the iterative programme delivery and development process.