No abstract

Background: Postoperative pain is common at the global level, despite considerable attempts for improvement, reflecting the complexity of offering effective pain relief. In this study, clinicians from Mexico, China, and eight European countries evaluated perioperative pain practices and patient-reported outcomes (PROs) in their hospitals as a basis for carrying out quality improvement (QI) projects in each country.Methods: PAIN OUT, an international perioperative pain registry, provided standardized methodology for assessing management and multi-dimensional PROs on the first postoperative day, in patients undergoing orthopaedic, general surgery, obstetric & gynaecology or urological procedures.Results: Between 2017 and 2019, data obtained from 10,415 adult patients in 105 wards, qualified for analysis. At the ward level: 50% (median) of patients reported worst pain intensities ≥7/10 NRS, 25% spent ≥50% of the time in severe pain and 20-34% reported severe ratings for pain-related functional and emotional interference. Demographic variables, country and surgical discipline explained a small proportion of the variation in the PROs, leaving about 88% unexplained. Most treatment processes varied considerably between wards. Ward effects accounted for about 7% and 32% of variation in PROs and treatment processes, respectively. Conclusions:This comprehensive evaluation demonstrates that many patients in this international cohort reported poor pain-related PROs on the first postoperative day. PROs and treatments varied greatly. Most of the variance of the PROs could not be explained. The findings served as a basis for devising and implementing QI programmes in participating hospitals.Author names are listed in the acknowledgement section.

No abstract

Autor za korespondenciju: Aleksandra Jukić, Služba anestezije i reanimacije sa intenzivnom negom, Institut za onkologiju i radiologiju Srbije, Pasterova 14, 11 000 Beograd, Telefon: +381604040948, E-mail: jukicaleksandra@yahoo.com

Introduction: Almost all chemotherapy agents in use so far have a demonstrated cardiotoxic effect. New therapy protocols have significantly improved long term prognosis of patients with malignant tumors and helped increase their life span, but it also caused the increase of incidence of onset of cardiotoxic effects. The aim of this study was to examine whether preoperatively administered chemotherapy agents influence the onset of perioperative cardiovascular complications and to examine the influence of certain factors on the onset of cardiotoxic effects.Materials and Methods: Retrospective cohort study was conducted at the National cancer research center of Serbia. Data were collected from medical case histories and anesthesiology documentation of patients without previous cardiovascular disease operated at this institution from January 2013-December 2017. The first group consisted of 1283 patients who were previously administered chemotherapy agents with demonstrated cardiotoxic effect with no regard to the type of tumor, stage of the disease and the period elapsed between the administration of chemotherapy and operation. The second group consisted of 1626 patients who were not administered chemotherapy. Perioperative presence or absence of cardiovascular effects like hypotension, hypertension, arrhythmias, and ischemic changes, signs of heart failure or thromboembolism were followed. Results:The incidence of onset of cardiotoxic effects in patients who were previously administered chemotherapy found in this study was 98.21%. Univariate regression analysis demonstrated significant correlation of intraoperative onset of cardiotoxic effects and previous administration of chemotherapy (RR=250.274; 95% CI=162.578 -385.274; p<0.001) as well as previously administered radiotherapy (RR=170.753; 95% CI=54.702 -533.005; p<0.001). Multivariate regression analysis demonstrated significant correlation of onset of cardiotoxic effects after administration of chemotherapy and the administration of radiotherapy (RR=190.506; 95% CI=120.118 -302.141; p<0.001). Conclusion:Patients who were previously administered chemotherapy have increased risk of developing perioperative cardiovascular complications. This requires thorough cardiac examination of these patients before the operation in order to better diagnose and treat consequences of cardiotoxic effects of chemotherapy.