Chronic Pain and Complications Common After Outpatient Surgery
/By Pat Anson
Outpatient surgeries are often touted for their convenience and cost savings. The surgeries are often minimally invasive, less painful, reduce trauma and recovery time, and save patients (and insurers) thousands of dollars because they don’t have to spend a night or two in the hospital in post-op care.
But two new studies in the UK – where outpatient procedures are called “day-case” surgeries – show the benefits of outpatient surgery are not universal and often make pre-existing pain conditions worse.
The studies, published here and here in the journal Anaesthesia, involved nearly 17,500 patients, and were conducted by a team of researchers at the NHS Foundation Trust and University Hospitals Plymouth.
In the first study, researchers found that 1 in 8 patients (11.8%) who had day-case surgery did not go home the same day and were admitted to hospital for various complications. For some patients who had prostate procedures (including those for cancer and benign prostate growth), the hospital admission rate was higher than 50%.
In the second study, one in 14 patients (7.2%) developed chronic pain or had their pain worsen at the surgery site. Some procedures had higher rates of chronic pain after 3 months, including orthopaedic (13.4%) and breast (10%) surgeries. Patients with chronic post-surgical pain also had lower quality of life scores than they did before the surgeries.
To be fair, many of the patients in the studies had chronic pain before their surgeries. Pain was already present at the surgery site in 39% of patients and was moderately severe. Chronic pain elsewhere in the body was also common. About one in four patients had opioid prescriptions prior to their surgeries, and a little over one in 10 used opioids daily.
These were the first studies of their kind in the UK, and fill an important gap in information about the outcomes of outpatient surgery. Because the UK’s National Health Service seeks to have 85% of eligible elective operations be done as day-case surgeries, researchers expect the outpatient workload to increase and the numbers of patients with chronic post-surgical pain to also grow..
“In summary, this large multicentre UK observational study on day-case surgery provides valuable new insights into a key patient group. We have shown that chronic pain is prevalent within this cohort, with a significantly higher burden than the general population,” the authors found.
“While most patients undergoing day-case surgery were discharged on the same day, the rate of unplanned inpatient admissions was unacceptably high, at twice the national target. This finding underscores a critical area for improvement, as reducing unplanned admissions would enhance the efficiency of day-case surgery and improve outcomes for patients. We highlight the complexity of day-case surgery, where even procedures that are generally seen as straightforward can still carry potential risks, especially for certain patient groups.”
Previous studies have found that female patients had higher rates of chronic post-surgical pain. The new studies found no difference in outcomes between males and females overall, but did show that gynaecological and breast surgeries (almost all female patients) had higher rates of chronic post-surgical pain. This suggests that medical specialties – rather than being female –- were behind the increased risk.
The studies also found that wealthier patients were less likely to have chronic post-surgical pain compared to the poorest ones. Patients of Asian, Black and mixed ethnicity were also more likely to report chronic post-surgical pain, which may be due to healthcare inequities and cultural difference in pain perception.
