Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

P.150 The Canadian Medical Student Interest Group in Neurosurgery (CaMSIGN) platform: a retrospective study on Canadian medical students

Background: The Canadian Medical Student Interest Group in Neurosurgery (CaMSIGN) is the first neurosurgery platform of its kind in Canada. Methods: In this retrospective study, data from CaMSIGN’s online platforms have been collated from February 2021 to the present and analyzed to show trends in user engagement. Results: CaMSIGN events generated 1,575 views on YouTube (384 from Canada). The total watch time was 170.3 hours, of which 43.9 hours were Canadian (28.5%). The total views normalized by the total number of students interested in neurosurgery was 17.12 hours. The normalized Canadian view was 4.17. 717 people follow the CaMSIGN Facebook account (normalized= 7.79). 152 people follow our Instagram (normalized= 1.65). 338 people follow our Twitter (normalized= 3.67). This number is comparable to that of estimated practicing neurosurgeons in Canada (333). A total of 32,974 people visited the Twitter page, with a monthly average of 2747.8. Lastly, the campaign website has had 5,811 visitors since its launch in June 2021 with a monthly average of 695.57 visitors. The number of website visitors has increased at a rate of 3.1327 visitors/month. Conclusions: Through this initiative, our aim has been to model a pan-Canadian approach to neurosurgery. </jats:p