Postoperative pain-related outcomes and perioperative pain management in China: a population-based study

Yanhong Liu, Saisong Xiao, Huikai Yang, Xuecai Lv, Aisheng Hou, Yulong Ma, Yandong Jiang, Chongyang Duan, Weidong Mi, CAPOPS Group, Jianjun Yang, Donghua Liu, Min Li, Jiaqiang Zhang, Yitian Yang, Yugang Diao, Ruquan Han, Shuang Song, Ning Li, Xiuqin Yue, Lan Yao, Xi'an Han, Jianzhong Zhang, Tianlong Wang, Guolin Wang, Yonghao Yue, Huiqun Jia, Junfang Rong, Yuelan Wang, Wei Zhang, Tiezheng Zhang, Yanhong Liu, Saisong Xiao, Huikai Yang, Xuecai Lv, Aisheng Hou, Yulong Ma, Yandong Jiang, Chongyang Duan, Weidong Mi, CAPOPS Group, Jianjun Yang, Donghua Liu, Min Li, Jiaqiang Zhang, Yitian Yang, Yugang Diao, Ruquan Han, Shuang Song, Ning Li, Xiuqin Yue, Lan Yao, Xi'an Han, Jianzhong Zhang, Tianlong Wang, Guolin Wang, Yonghao Yue, Huiqun Jia, Junfang Rong, Yuelan Wang, Wei Zhang, Tiezheng Zhang

Abstract

Background: Postoperative pain poses a significant challenge to the healthcare system and patient satisfaction and is associated with chronic pain and long-term narcotic use. However, systemic assessment of the quality of postoperative pain management in China remains unavailable.

Methods: In this cross-sectional study, we analyzed data collected from a nationwide registry, China Acute Postoperative Pain Study (CAPOPS), between September 2019 and August 2021. Patients aged 18 years or above were required to complete a self-reported pain outcome questionnaire on the first postoperative day (POD1). Perioperative pain management and pain-related outcomes, including the severity of pain, adverse events caused by pain or pain management, and perception of care and satisfaction with pain management were analyzed.

Findings: A total of 26,193 adult patients were enrolled. There were 48.7% of patients who had moderate-to-severe pain on the first day after surgery, and pain severity was associated with poor recovery and patient satisfaction. The systemic opioid use was 68% on the first day after surgery, and 89% of them were used with intravenous patient-controlled analgesia, while the rate of postoperative nerve blocks was low.

Interpretation: Currently, almost half of patients still suffer from moderate-to-severe pain after surgery in China. The relatively high rate of systemic opioid use and low rate of nerve blocks used after surgery suggests that more effort is needed to improve the management of acute postoperative pain in China.

Funding: National Key Research and Development Program of China (No. 2018YFC2001905).

Keywords: Acute postoperative pain; China; Perioperative pain management; Postoperative pain-related outcomes.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2023 The Authors.

Figures

Fig. 1
Fig. 1
Case-screening flowchart.
Fig. 2
Fig. 2
The prevalence of mild, moderate, and severe acute postoperative pain in different surgical specialties (panel A) and in different surgical procedures (panel B). Panel A shows that obstetrics and burn and plastic surgery has the highest proportion of cases with severe pain (28.90% and 30.52%, respectively), while thoracic surgery and burn and plastic surgery have the highest proportion of cases with moderate pain (45.82% and 44.19%, respectively). Panel B shows that open reduction and internal fixation of limb fractures, cesarean section, and bariatric surgery have the highest prevalence of severe pain (32.74%, 30.33%, and 28.40%, respectively), partial or total gastrectomy, autologous costal cartilage rhinoplasty, and pulmonary and bronchial resection have the highest prevalence of moderate pain (48.23%, 47.51%, and 45.54%, respectively).
Fig. 3
Fig. 3
The distribution of patient reported pain-related outcomes in five disciplines (Obstetrics, Gynecology, Thoracic Surgery, General Surgery, and Orthopedics). Panel A shows pain inference with activities in bed. Panel B shows pain inference with sleeping. Panel C shows Emotional impairment anxiety. Panel D shows satisfaction with pain treatment.

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