Prevalence of Pain in Postoperative Patients for One Week After Ambulatory Surgery

Tuesday, 23 July 2013: 11:25 AM

Jan Odom-Forren, PhD, RN, CPAN, FAAN1
Carrell Rush, MPH1
Christian C. Apfel, MD, PhD2
(1)College of Nursing, University of Kentucky, Lexington, KY
(2)Mt. Zion Hospital, University of California, San Francisco, San Francisco, CA

Learning Objective 1: The learner will be able to describe the prevalence of pain in patients after ambulatory surgery.

Learning Objective 2: The learner will be able to determine factors put the patient at risk for severe pain.

Purpose: Over 35 million patients undergo ambulatory surgery each year in the United States, and similar data from the World Health Organization supports an increase in ambulatory surgery internationally.    Little is known about postoperative pain in the ambulatory setting.  The purpose of this study was to determine the prevalence and describe the progression of postoperative pain for one week after ambulatory surgery.

Methods: A total of 248 patients who experienced ambulatory surgery were included in this secondary analysis.  The primary study included data on incidence (yes/no) and intensity (0=none;10=worst) of post discharge nausea and vomiting over 7 days.  Pain was also measured with a visual analog scale (0= none; 10 = worst).  

Results: On the day of surgery, 53.7% of the patient experienced moderate to severe pain with 51.2 % experiencing moderate to severe pain on postoperative Day 1 decreasing to 18.6% on Day 7.  Patients with surgeries that involved the shoulder and knee reported significantly higher mean levels of pain.  Postoperative level of pain was significantly related to the presence of nausea on each of the 7 days with patients who experienced nausea also experiencing higher levels of pain.  In a logistic regression, age less than 50 with an odds ratio of 2.7 and arthroscopy approach to surgery with an odds ratio of 11.9 were the two independent variables that predicted presence of severe pain.

Conclusion: This study confirmed that a large number of ambulatory surgery patients continue to experience moderate to severe pain over 7 days after ambulatory surgery.  The type of surgical procedure can influence the intensity of pain and should be considered in an analgesic management plan.  A symptom cluster that includes pain and nausea requires further research to determine how best to self-manage multiple symptoms at home.