Thirty percent of patients have moderate to severe pain 24 hr after ambulatory surgery: a survey of 5,703 patients.
OBJECTIVE
Postoperative pain is the commonest reason for delayed discharge and unanticipated hospital admission after ambulatory surgery. We investigated the severity of pain at 24 hr postoperatively and determined the most painful procedures. The need for further medical advice and clarity of postoperative analgesia instructions were also studied.


METHODS
Five thousand seven hundred and three ambulatory surgical patients were telephoned 24 hr postoperatively. Patients graded their pain using the ten-point self-assessing verbal scale (0 = no pain, 10 = worst pain). Data were analyzed in two groups, those with moderate to severe pain (pain score 4-10) and those with no or mild pain (0-3).


RESULTS
Thirty percent of patients (1,495/5,703) had moderate to severe pain. Microdiscectomy, laparoscopic cholecystectomy, shoulder surgery, elbow/hand surgery, ankle surgery, inguinal hernia repair, and knee surgery were identified as the procedures causing most pain at 24 hr. 13.2% of patients needed medical advice by telephone, 1.4% made an unplanned visit to a doctor while the rate of readmission to the hospital was 0.08%. Ninety-eight percent found postoperative instruction sheets and advice helpful. Eighty-eight percent of patients indicated that analgesic instructions were absolutely clear.


CONCLUSIONS
This study has identified the more painful common ambulatory surgical procedures which will allow take home analgesia to be tailored according to individual procedures. Further improvement in analgesic instructions may help in better pain management of ambulatory surgery patients.
McGrath
Brid
B
Department of Anesthesia, EC 2-046, Toronto Western Hospital, 399 Bathurst St., Toronto, Ontario M5T 2S8, Canada.
Elgendy
Hany
H
Chung
Frances
F
Kamming
Damon
D
Curti
Bruna
B
King
Shirley
S
D000359:Aftercare / Q000706:statistics & numerical data; D000556:Ambulatory Surgical Procedures / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use; D000842:Ankle / Q000601:surgery; D001182:Arthroscopy / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000706:statistics & numerical data; D017586:Diskectomy / Q000706:statistics & numerical data; D004550:Elbow / Q000601:surgery; D005500:Follow-Up Studies; D006225:Hand / Q000601:surgery; D006552:Hernia, Inguinal / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008866:Microsurgery / Q000706:statistics & numerical data; D009864:Ontario / Q000453:epidemiology; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology*; D010353:Patient Education as Topic / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011446:Prospective Studies; D012785:Shoulder Joint / Q000601:surgery
D000700:Analgesics