Patient-reported outcomes, postoperative pain and pain relief after day-case surgery (POPPY): short-term peri-operative analgesic use.

INTRODUCTION: An increasing proportion of complex surgical procedures are being performed in the UK as day-cases, with variable and limited follow up. Discharge prescriptions must provide adequate analgesia, while considering the safety of the patient and public, following best practice guidance and good opioid stewardship. METHODS: Data were collected by the POPPY study, a national, prospective, observational study measuring short- and longer-term patient-reported outcomes relating to postoperative pain and pain relief after day-case surgery in adults. We aimed to describe pre-operative and early postoperative analgesia in the first 7 days following surgery alongside describing prescribing practices; analgesic use; patient satisfaction with pain relief; and the need for further healthcare support for pain management. RESULTS: Of the 7839 patients recruited, 1985 (25.3%) were taking opioid analgesics pre-operatively, of whom 1366 (68.8%) reported pain of more than 3 months duration. After surgery, 3628 (46.4%) patients received opioid analgesics and 1229 (25.9%) reported taking opioid analgesics on day 7. Of those patients prescribed opioids after surgery, 474 (22.8%) reported never taking them. Over three-quarters of patients (3876, 76.7%) reported being satisfied with their analgesia, but 922 (18.2%) sought further help for pain relief, most commonly from their GP. Patients taking postoperative opioids reported higher pain scores; lower satisfaction scores; lower quality of recovery scores; and had higher rates of seeking help to manage pain after discharge. DISCUSSION: Most patients were satisfied with pain relief after surgery but a large proportion were still taking opioid medications on day 7. Nearly 1 in 5 patients sought additional help for pain relief, potentially constituting a significant burden on community health services. These findings suggest improvements could be made in the systems for day-case patient support after discharge.