Around one in eight patients undergoing day-case surgery in the UK are admitted to hospital unexpectedly, according to two new studies published in Anaesthesia, the journal of the Association of Anaesthetists. The research also found that one in 14 patients develop chronic pain at the site of their operation three months after their procedure.
The studies were conducted by Dr Martha Belete from Torbay and South Devon NHS Foundation Trust and Dr Adam Brayne from University Hospitals Plymouth NHS Trust, along with colleagues from the POPPY Consortium (Patient reported Outcomes, Postoperative Pain and pain relief after daY-case surgery). These are the first studies to examine chronic post-surgical pain following day-case surgery in the UK.
Day-case surgery is defined as an operation where a patient is admitted and discharged on the same day. The UK's National Health Service (NHS) aims for 85% of eligible elective surgeries to be performed this way. This approach offers several benefits such as faster recovery, reduced risk of hospital-acquired infections, increased efficiency for healthcare systems, lower costs, and fewer cancellations.
Chronic post-surgical pain refers to pain at the surgical site that persists or worsens three months after surgery and is not caused by another condition. Prior to these studies, its prevalence after day-case procedures was unknown. Treatment options for chronic post-surgical pain remain limited.
In the first study, researchers screened 9,618 patients across 199 UK sites; 7,839 were eligible after exclusions. Unplanned admission occurred in 1,131 cases (11.8%), most often among those with more complex surgeries or pre-existing health issues. Some procedures had even higher admission rates; for example, over half of prostate operations resulted in unplanned admissions.
The authors stated: "In the UK, over one third of patients presenting for day-case surgery are in pain, which is mostly chronic in duration. One in four have access to opioid medications and a little over one in 10 are using opioids daily. More than one in 10 do not receive their planned surgery as a day-case and readmission rates for day-case surgery do not meet suggested targets."
The second study followed up with patients through mobile phone questionnaires on days 1, 3, 7 and 97 after their operation. Of those contacted at day 97 (three months), responses were received from 3,442 patients out of the original group of 7,839. The rate of chronic post-surgical pain was found to be 7.2%, equivalent to about one in every fourteen patients.
Higher rates of persistent pain were observed among orthopaedic (13.4%) and breast (10%) surgeries. The data also showed that people living with greater deprivation were more likely to experience ongoing pain compared with wealthier groups.
On this point about deprivation's impact on outcomes, the authors commented: "The least deprived quintile is associated with a reduced risk of chronic post-surgical pain. Ill health often comes with financial, employment and social burdens that may be endured more easily by those with more financial security."
They added: "In the UK, given the active selection of patient suitability for day-case surgery, combined with modified surgical and anaesthetic techniques and enhanced recovery pathways, it could have been anticipated that the prevalence of chronic post-surgical pain in this cohort would be lower. By including representative, prospective data across all four nations, the findings of this study suggest that it is not. Therefore as surgical workload increases we can expect numbers of patients with chronic post-surgical pain to increase."
While previous research suggested female sex was linked to higher risk for chronic post-surgical pain, these new findings indicate that certain types of operations—such as gynaecological or breast procedures—are more closely associated with increased risk than gender itself.
"This is the first large UK multicenter prospective observational study exploring chronic post-surgical pain after day-case surgery," they concluded. "Chronic post-surgical pain is common after day-case surgery and is associated with reduced quality of life."
