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Breastfeeding Medicine : the Official... Feb 2023While breast milk is widely accepted as the best source of nutrients for almost all newborns, breastfeeding can be especially challenging for preterm and low birth... (Meta-Analysis)
Meta-Analysis Review
While breast milk is widely accepted as the best source of nutrients for almost all newborns, breastfeeding can be especially challenging for preterm and low birth weight (LBW) infants. With increased risk of admission to neonatal intensive care units (NICUs) and separation from parents, this population experiences significant barriers to successful breastfeeding. Thus, it is crucial to identify interventions that can optimize breastfeeding for preterm and LBW infants that is continued from birth and admission, through to hospital discharge and beyond. To identify and analyze evidence-based interventions that promote any and exclusive breastfeeding among preterm and LBW neonates at discharge and/or postdischarge from hospital. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. Searches were performed in the following databases: MEDLINE Ovid, EMBASE, Web of Science, and Cumulative Index to Nursing and Allied Health (CINAHL). From the 42 studies included, 6 groups of intervention types were identified: educational and breastfeeding support programs, early discharge, oral stimulation, artificial teats and cups, kangaroo mother care (KMC), and supportive policies within NICUs. All groupings of interventions were associated with significantly increased rates of any breastfeeding at discharge. All types of interventions except artificial teats/cups and oral stimulation showed statistically significant increases in exclusive breastfeeding at discharge. KMC demonstrated the highest increased odds of breastfeeding at discharge among preterm and LBW infants. A variety of effective interventions exist to promote breastfeeding among hospitalized preterm and LBW infants. Hospital settings hold unique opportunities for successful breastfeeding promotion. PROSPERO registration: CRD42021252610.
Topics: Female; Infant, Newborn; Child; Humans; Kangaroo-Mother Care Method; Intensive Care Units, Neonatal; Breast Feeding; Patient Discharge; Aftercare; Weight Gain; Infant, Low Birth Weight
PubMed: 36595356
DOI: 10.1089/bfm.2022.0151 -
Journal of Patient Safety Jun 2021Teach-back methods are reported to improve patient outcomes by encouraging patient understanding and participation and are increasingly being used in various clinical... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Teach-back methods are reported to improve patient outcomes by encouraging patient understanding and participation and are increasingly being used in various clinical settings. This study attempts to identify the effectiveness of discharge education using the teach-back method on 30-day readmission.
METHODS
MEDLINE, CINAHL, Embase, The Cochrane Library, and Web of Science were used to search experimental studies. The search terms were "discharged patient," "teach-back," and "30-day readmission" published in English up until July 2017. Two trained reviewers performed a critical appraisal of retrieved studies using the Risk of Bias Assessment tool for Nonrandomized Studies. Data were analyzed using Cochrane Review Manager (Revman) software 5.2.
RESULTS
A total of five studies were analyzed (3 studies on heart failure, 1 study on total joint replacement, and 1 study on a coronary artery bypass graft). The main content of the teach-back education was to confirm and reinforce the patients' comprehension of health-related information. Among the five studies, three studies were included in the meta-analysis. The odds ratio of 30-day readmission for discharge education with the teach-back method and usual care was 0.55 (95% confidence interval, 0.34-0.91; P = 0.02). The I2 score was 0%, which means that the analyzed studies are homogeneous.
CONCLUSIONS
The results indicate that discharge education with the teach-back method resulted in a 45% reduction in 30-day readmission. However, only a few studies were included in the analysis, and they showed a high risk of selection bias. Therefore, we suggest that well-designed randomized controlled trials be conducted.
Topics: Humans; Patient Discharge; Patient Readmission
PubMed: 30882616
DOI: 10.1097/PTS.0000000000000596 -
The Cochrane Database of Systematic... Nov 2021Hip fracture is a major cause of morbidity and mortality in older people, and its impact on society is substantial. After surgery, people require rehabilitation to help... (Review)
Review
BACKGROUND
Hip fracture is a major cause of morbidity and mortality in older people, and its impact on society is substantial. After surgery, people require rehabilitation to help them recover. Multidisciplinary rehabilitation is where rehabilitation is delivered by a multidisciplinary team, supervised by a geriatrician, rehabilitation physician or other appropriate physician. This is an update of a Cochrane Review first published in 2009.
OBJECTIVES
To assess the effects of multidisciplinary rehabilitation, in either inpatient or ambulatory care settings, for older people with hip fracture.
SEARCH METHODS
We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, CENTRAL, MEDLINE and Embase (October 2020), and two trials registers (November 2019).
SELECTION CRITERIA
We included randomised and quasi-randomised trials of post-surgical care using multidisciplinary rehabilitation of older people (aged 65 years or over) with hip fracture. The primary outcome - 'poor outcome' - was a composite of mortality and decline in residential status at long-term (generally one year) follow-up. The other 'critical' outcomes were health-related quality of life, mortality, dependency in activities of daily living, mobility, and related pain.
DATA COLLECTION AND ANALYSIS
Pairs of review authors independently performed study selection, assessed risk of bias and extracted data. We pooled data where appropriate and used GRADE for assessing the certainty of evidence for each outcome.
MAIN RESULTS
The 28 included trials involved 5351 older (mean ages ranged from 76.5 to 87 years), usually female, participants who had undergone hip fracture surgery. There was substantial clinical heterogeneity in the trial interventions and populations. Most trials had unclear or high risk of bias for one or more items, such as blinding-related performance and detection biases. We summarise the findings for three comparisons below. Inpatient rehabilitation: multidisciplinary rehabilitation versus 'usual care' Multidisciplinary rehabilitation was provided primarily in an inpatient setting in 20 trials. Multidisciplinary rehabilitation probably results in fewer cases of 'poor outcome' (death or deterioration in residential status, generally requiring institutional care) at 6 to 12 months' follow-up (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.80 to 0.98; 13 studies, 3036 participants; moderate-certainty evidence). Based on an illustrative risk of 347 people with hip fracture with poor outcome in 1000 people followed up between 6 and 12 months, this equates to 41 (95% CI 7 to 69) fewer people with poor outcome after multidisciplinary rehabilitation. Expressed in terms of numbers needed to treat for an additional harmful outcome (NNTH), 25 patients (95% CI 15 to 100) would need to be treated to avoid one 'poor outcome'. Subgroup analysis by type of multidisciplinary rehabilitation intervention showed no evidence of subgroup differences. Multidisciplinary rehabilitation may result in fewer deaths in hospital but the confidence interval does not exclude a small increase in the number of deaths (RR 0.77, 95% CI 0.58 to 1.04; 11 studies, 2455 participants; low-certainty evidence). A similar finding applies at 4 to 12 months' follow-up (RR 0.91, 95% CI 0.80 to 1.05; 18 studies, 3973 participants; low-certainty evidence). Multidisciplinary rehabilitation may result in fewer people with poorer mobility at 6 to 12 months' follow-up (RR 0.83, 95% CI 0.71 to 0.98; 5 studies, 1085 participants; low-certainty evidence). Due to very low-certainty evidence, we have little confidence in the findings for marginally better quality of life after multidisciplinary rehabilitation (1 study). The same applies to the mixed findings of some or no difference from multidisciplinary rehabilitation on dependence in activities of daily living at 1 to 4 months' follow-up (measured in various ways by 11 studies), or at 6 to 12 months' follow-up (13 studies). Long-term hip-related pain was not reported. Ambulatory setting: supported discharge and multidisciplinary home rehabilitation versus 'usual care' Three trials tested this comparison in 377 people mainly living at home. Due to very low-certainty evidence, we have very little confidence in the findings of little to no between-group difference in poor outcome (death or move to a higher level of care or inability to walk) at one year (3 studies); quality of life at one year (1 study); in mortality at 4 or 12 months (2 studies); in independence in personal activities of daily living (1 study); in moving permanently to a higher level of care (2 studies) or being unable to walk (2 studies). Long-term hip-related pain was not reported. One trial tested this comparison in 240 nursing home residents. There is low-certainty evidence that there may be no or minimal between-group differences at 12 months in 'poor outcome' defined as dead or unable to walk; or in mortality at 4 months or 12 months. Due to very low-certainty evidence, we have very little confidence in the findings of no between-group differences in dependency at 4 weeks or at 12 months, or in quality of life, inability to walk or pain at 12 months.
AUTHORS' CONCLUSIONS
In a hospital inpatient setting, there is moderate-certainty evidence that rehabilitation after hip fracture surgery, when delivered by a multidisciplinary team and supervised by an appropriate medical specialist, results in fewer cases of 'poor outcome' (death or deterioration in residential status). There is low-certainty evidence that multidisciplinary rehabilitation may result in fewer deaths in hospital and at 4 to 12 months; however, it may also result in slightly more. There is low-certainty evidence that multidisciplinary rehabilitation may reduce the numbers of people with poorer mobility at 12 months. No conclusions can be drawn on other outcomes, for which the evidence is of very low certainty. The generally very low-certainty evidence available for supported discharge and multidisciplinary home rehabilitation means that we are very uncertain whether the findings of little or no difference for all outcomes between the intervention and usual care is true. Given the prevalent clinical emphasis on early discharge, we suggest that research is best orientated towards early supported discharge and identifying the components of multidisciplinary inpatient rehabilitation to optimise patient recovery within hospital and the components of multidisciplinary rehabilitation, including social care, subsequent to hospital discharge.
Topics: Activities of Daily Living; Aged; Aged, 80 and over; Female; Hip Fractures; Humans; Inpatients; Patient Discharge; Quality of Life
PubMed: 34766330
DOI: 10.1002/14651858.CD007125.pub3 -
Critical Care (London, England) Feb 2020To quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary... (Meta-Analysis)
Meta-Analysis
BACKGROUND
To quantitatively summarize the available epidemiological evidence on the survival rate of out-of-hospital cardiac arrest (OHCA) patients who received cardiopulmonary resuscitation (CPR).
METHODS
We systematically searched the PubMed, Embase, and Web of Science databases, and the references of retrieved articles were manually reviewed to identify studies reporting the outcome of OHCA patients who received CPR. The overall incidence and outcome of OHCA were assessed using a random-effects meta-analysis.
RESULTS
A total of 141 eligible studies were included in this meta-analysis. The pooled incidence of return of spontaneous circulation (ROSC) was 29.7% (95% CI 27.6-31.7%), the rate of survival to hospital admission was 22.0% (95% CI 20.7-23.4%), the rate of survival to hospital discharge was 8.8% (95% CI 8.2-9.4%), the pooled 1-month survival rate was 10.7% (95% CI 9.1-13.3%), and the 1-year survival rate was 7.7% (95% CI 5.8-9.5%). Subgroup analysis showed that survival to hospital discharge was more likely among OHCA patients whose cardiac arrest was witnessed by a bystander or emergency medical services (EMS) (10.5%; 95% CI 9.2-11.7%), who received bystander CPR (11.3%, 95% CI 9.3-13.2%), and who were living in Europe and North America (Europe 11.7%; 95% CI 10.5-13.0%; North America: 7.7%; 95% CI 6.9-8.6%). The survival to discharge (8.6% in 1976-1999 vs. 9.9% in 2010-2019), 1-month survival (8.0% in 2000-2009 vs. 13.3% in 2010-2019), and 1-year survival (8.0% in 2000-2009 vs. 13.3% in 2010-2019) rates of OHCA patients who underwent CPR significantly increased throughout the study period. The Egger's test did not indicate evidence of publication bias for the outcomes of OHCA patients who underwent CPR.
CONCLUSIONS
The global survival rate of OHCA patients who received CPR has increased in the past 40 years. A higher survival rate post-OHCA is more likely among patients who receive bystander CPR and who live in Western countries.
Topics: Adult; Aged; Cardiopulmonary Resuscitation; Emergency Medical Services; Female; Hospitalization; Humans; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Patient Discharge; Survival Rate
PubMed: 32087741
DOI: 10.1186/s13054-020-2773-2 -
BMJ Quality & Safety Aug 2022Patients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover... (Meta-Analysis)
Meta-Analysis
Medication-related interventions to improve medication safety and patient outcomes on transition from adult intensive care settings: a systematic review and meta-analysis.
BACKGROUND
Patients recovering from an episode in an intensive care unit (ICU) frequently experience medication errors on transition to the hospital ward. Structured handover recommendations often underestimate the challenges and complexity of ICU patient transitions. For adult ICU patients transitioning to a hospital ward, it is currently unclear what interventions reduce the risks of medication errors.The aims were to examine the impact of medication-related interventions on medication and patient outcomes on transition from adult ICU settings and identify barriers and facilitators to implementation.
METHODS
The systematic review protocol was preregistered on PROSPERO. Six electronic databases were searched until October 2020 for controlled and uncontrolled study designs that reported medication-related (ie, de-prescribing; medication errors) or patient-related outcomes (ie, mortality; length of stay). Risk of bias (RoB) assessment used V.2.0 and ROBINS-I Cochrane tools. Where feasible, random-effects meta-analysis was used for pooling the OR across studies. The quality of evidence was assessed by Grading of Recommendations, Assessment, Development and Evaluations.
RESULTS
Seventeen studies were eligible, 15 (88%) were uncontrolled before-after studies. The intervention components included education of staff (n=8 studies), medication review (n=7), guidelines (n=6), electronic transfer/handover tool or letter (n=4) and medicines reconciliation (n=4). Overall, pooled analysis of all interventions reduced risk of inappropriate medication continuation at ICU discharge (OR=0.45 (95% CI 0.31 to 0.63), I=55%, n=9) and hospital discharge (OR=0.39 (95% CI 0.2 to 0.76), I=75%, n=9). Multicomponent interventions, based on education of staff and guidelines, demonstrated no significant difference in inappropriate medication continuation at the ICU discharge point (OR 0.5 (95% CI 0.22 to 1.11), I=62%, n=4), but were very effective in increasing de-prescribing outcomes on hospital discharge (OR 0.26 (95% CI 0.13 to 0.55), I=67%, n=6)). Facilitators to intervention delivery included ICU clinical pharmacist availability and participation in multiprofessional ward rounds, while barriers included increased workload associated with the discharge intervention process.
CONCLUSIONS
Multicomponent interventions based on education of staff and guidelines were effective at achieving almost four times more de-prescribing of inappropriate medication by the time of patient hospital discharge. Based on the findings, practice and policy recommendations are made and guidance is provided on the need for, and design of theory informed interventions in this area, including the requirement for process and economic evaluations.
Topics: Adult; Critical Care; Humans; Intensive Care Units; Medication Errors; Patient Discharge; Pharmacists
PubMed: 35042765
DOI: 10.1136/bmjqs-2021-013760 -
The European Respiratory Journal Jan 2020This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been...
This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90-95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.
Topics: Adult; Bronchopulmonary Dysplasia; Child; Humans; Infant, Newborn; Infant, Premature; Patient Discharge
PubMed: 31558663
DOI: 10.1183/13993003.00788-2019 -
BMC Geriatrics Dec 2020One of the most challenging issues for the elderly population is the clinical state of frailty. Frailty is defined as a cumulative decline across psychological,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
One of the most challenging issues for the elderly population is the clinical state of frailty. Frailty is defined as a cumulative decline across psychological, physical, and social functioning. Hospitalization is one of the most stressful events for older people who are becoming frail. The aim of the present study was to determine the effectiveness of interventions focused on management of frailty in hospitalized frail older adults.
METHODS
A systematic review and meta-analysis of research was conducted using the Medline, Embase, Cochrane, ProQuest, CINAHL, SCOPUS and Web of Science electronic databases for papers published between 2000 and 2019. Randomized controlled studies were included that were aimed at the management of frailty in hospitalized older adults. The outcomes which were examined included frailty; physical, psychological, and social domains; length of stay in hospital; re-hospitalization; mortality; patient satisfaction; and the need for post discharge placement.
RESULTS
After screening 7976 records and 243 full-text articles, seven studies (3 interventions) were included, involving 1009 hospitalized older patients. The quality of these studies was fair to poor and the risk of publication bias in the studies was low. Meta-analysis of the studies showed statistically significant differences between the intervention and control groups for the management of frailty in hospitalized older adults (ES = 0.35; 95% CI: 0. 067-0.632; z = 2.43; P < 0.015). However, none of the included studies evaluated social status, only a few of the studies evaluated other secondary outcomes. The analysis also showed that a Comprehensive Geriatric Assessment unit intervention was effective in addressing physical and psychological frailty, re-hospitalization, mortality, and patient satisfaction.
CONCLUSIONS
Interventions for hospitalized frail older adults are effective in management of frailty. Multidimensional interventions conducted by a multidisciplinary specialist team in geriatric settings are likely to be effective in the care of hospitalized frail elderly. Due to the low number of RCTs carried out in a hospital setting and the low quality of existing studies, there is a need for new RCTs to be carried out to generate a protocol appropriate for frail older people.
Topics: Aftercare; Aged; Aged, 80 and over; Frail Elderly; Frailty; Geriatric Assessment; Humans; Patient Discharge
PubMed: 33272208
DOI: 10.1186/s12877-020-01935-8 -
Advances in Skin & Wound Care May 2022To evaluate if ostomy care pathways improve outcomes for adults anticipating or living with an ostomy.
OBJECTIVE
To evaluate if ostomy care pathways improve outcomes for adults anticipating or living with an ostomy.
DATA SOURCES
In this systematic review, the authors searched the MEDLINE, CINAHL, Cochrane Central, and EMBASE databases.
STUDY SELECTION
Studies were included if they met the following criteria: written in English, targeted adults anticipating or currently living with an ostomy, evaluated the impact of two or more components of an ostomy care pathway, and included one or more of the pertinent outcomes (patient satisfaction, hospital length of stay, hospital readmission rates, and staff satisfaction).
DATA EXTRACTION
Details recorded included design, setting, descriptions of intervention and control groups, patient characteristics, outcomes, data collection tools, effect size, and potential harms.
DATA SYNTHESIS
Of 5,298 total records, 11 met the inclusion criteria: 2 randomized controlled trials and 9 nonrandomized studies. The overall quality of the studies was low. Of the four studies that examined patient satisfaction, all studies reported improvement or positive satisfaction rates. Of the six studies that evaluated hospital length of stay, five noted a decrease in length of stay. Of the eight studies that evaluated hospital readmission rates, five found a reduction in hospital readmission rates. No studies reported on staff satisfaction.
CONCLUSIONS
Ostomy care pathways included preoperative education and counseling, postoperative education and discharge planning, and outpatient home visits and telephone follow-ups. Ostomy care pathways may contribute to patient satisfaction and decrease both hospital length of stay and hospital readmission rates. However, higher-quality literature is needed to be confident in the effectiveness of ostomy care pathways.
Topics: Adult; Critical Pathways; Humans; Length of Stay; Ostomy; Patient Discharge; Patient Readmission
PubMed: 35442921
DOI: 10.1097/01.ASW.0000823976.96962.b6 -
International Journal of Nursing Studies Apr 2023There is some evidence to suggest that discharge education may reduce the risk of postoperative complications, however, a critical evaluation of the body of evidence is... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is some evidence to suggest that discharge education may reduce the risk of postoperative complications, however, a critical evaluation of the body of evidence is needed.
OBJECTIVE
To assess the effect of discharge education interventions versus standard education given to general surgery patients prior to, or up to 30-days of hospital discharge on clinical and patient-reported outcomes.
DESIGN
Systematic review and meta-analysis. Clinical outcomes were 30-day surgical site infection incidence and re-admission up to 28 days. Patient-reported outcomes included patient knowledge, self-confidence, satisfaction, and quality of life.
SETTING
Participants were recruited from hospitals.
PARTICIPANTS
Adult general surgical patients.
METHODS
MEDLINE (Pubmed), CINAHL (EBSCO), EMBASE (Elsevier) and the Cochrane Library were searched in February 2022. Randomised controlled trials and non-randomised studies of interventions published between 2010 and 2022, with adults undergoing general surgical procedures receiving discharge education on surgical recovery, including wound management, were eligible for inclusion. Quality appraisal was undertaken using the Cochrane Risk of Bias 2 and the Risk of Bias Assessment Tool for Nonrandomised Studies. The Grading of Assessment, Development, Recommendations, and Evaluation was used to assess the certainty of the body of evidence based on the outcomes of interest.
RESULTS
Ten eligible studies (eight randomised control trials and two non-randomised studies of interventions) with 965 patients were included. Six randomised control trials assessed the effect of discharge education interventions on 28-day readmission (Odds ratio 0.88, 95 % confidence interval 0.56-1.38). Two randomised control trials assessed the effect of discharge education interventions on surgical site infection incidence (Odds ratio = 0.84, 95 % confidence interval 0.39-1.82). The results of the non-randomised studies of interventions were not pooled due to heterogeneity in outcome measures. The risk of bias was either moderate or high for all outcomes, and the body of evidence using GRADE was judged as very low for all outcomes studied.
CONCLUSIONS
The impact of discharge education on the clinical and patient-reported outcomes of patients undergoing general surgery cannot be determined due to the uncertainty of the evidence base. Despite the increased use of web-based interventions to deliver discharge education to general surgery patients, larger samples in more rigorous multicentre randomised control trials with parallel process evaluations are needed to better understand the effect of discharge education on clinical and patient-reported outcomes.
REGISTRATION
PROSPERO CRD42021285392.
TWEETABLE ABSTRACT
Discharge education may reduce the likelihood of surgical site infection and hospital readmission but the body of evidence is inconclusive.
Topics: Adult; Humans; Surgical Wound Infection; Patient Discharge; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 36871540
DOI: 10.1016/j.ijnurstu.2023.104471 -
Patient-Reported Opioid Analgesic Use After Discharge from Surgical Procedures: A Systematic Review.Pain Medicine (Malden, Mass.) Jan 2022This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use after surgery.
OBJECTIVE
This systematic review synthesizes evidence on patient-reported outpatient opioid analgesic use after surgery.
METHODS
We searched PubMed (February 2019) and Web of Science and Embase (June 2019) for U.S. studies describing patient-reported outpatient opioid analgesic use. Two reviewers extracted data on opioid analgesic use, standardized the data on use , and performed independent quality appraisals based on the Cochrane Risk of Bias Tool and an adapted Newcastle-Ottawa scale.
RESULTS
Ninety-six studies met the eligibility criteria; 56 had sufficient information to standardize use in oxycodone 5-mg tablets. Patient-reported opioid analgesic use varied widely by procedure type; knee and hip arthroplasty had the highest postoperative opioid use, and use after many procedures was reported as <5 tablets. In studies that examined excess tablets, 25-98% of the total tablets prescribed were reported to be excess, with most studies reporting that 50-70% of tablets went unused. Factors commonly associated with higher opioid analgesic use included preoperative opioid analgesic use, higher inpatient opioid analgesic use, higher postoperative pain scores, and chronic medical conditions, among others. Estimates also varied across studies because of heterogeneity in study design, including length of follow-up and inclusion/exclusion criteria.
CONCLUSION
Self-reported postsurgery outpatient opioid analgesic use varies widely both across procedures and within a given procedure type. Contributors to within-procedure variation included patient characteristics, prior opioid use, intraoperative and perioperative factors, and differences in the timing of opioid use data collection. We provide recommendations to help minimize variation caused by study design factors and maximize interpretability of forthcoming studies for use in clinical guidelines and decision-making.
Topics: Analgesics, Opioid; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Humans; Pain, Postoperative; Patient Discharge; Patient Reported Outcome Measures
PubMed: 34347101
DOI: 10.1093/pm/pnab244