Healthcare delivery gaps in pain management within the first 3 months after discharge from inpatient noncardiac surgeries: a scoping review

Janny X C Ke; Maya de Vos; Katarina Kojic; Mark Hwang; Jason Park; Heather Stuart; Jill Osborn; Alana Flexman; Lindsay Blake; Daniel I McIsaac

doi:10.1016/j.bja.2023.08.006

Healthcare delivery gaps in pain management within the first 3 months after discharge from inpatient noncardiac surgeries: a scoping review

Br J Anaesth. 2023 Nov;131(5):925-936. doi: 10.1016/j.bja.2023.08.006. Epub 2023 Sep 15.

Authors

Affiliations

¹ Department of Anesthesia, Providence Health Care, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, NS, Canada. Electronic address: janny.ke@ubc.ca.
² Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
³ Department of Anesthesia, Providence Health Care, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁴ Undergraduate Medical Education Program, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
⁵ Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada.
⁶ University of Arkansas for Medical Sciences Library, Little Rock, AK, USA.
⁷ Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada.

PMID: 37716887
DOI: 10.1016/j.bja.2023.08.006

Abstract

Background: Poor pain control during the postoperative period has negative implications for recovery, and is a critical risk factor for development of persistent postsurgical pain. The aim of this scoping review is to identify gaps in healthcare delivery that patients undergoing inpatient noncardiac surgeries experience in pain management while recovering at home.

Methods: Searches were conducted by a medical librarian in PubMed, MEDLINE, EMBASE, EBSCO CINAHL, Web of Science, and Cochrane Database of Systematic Reviews for articles published between 2016 and 2022. Inclusion criteria were adults (≥18 yr), English language, inpatient noncardiac surgery, and included at least one gap in care for acute and/or persistent pain management after surgery within the first 3 months of recovery at home. Two reviewers independently screened articles for inclusion and extracted data. Quotations from each article related to gaps in care were synthesised using thematic analysis.

Results: There were 4794 results from databases and grey literature, of which 38 articles met inclusion criteria. From these, 23 gaps were extracted, encompassing all six domains of healthcare delivery (capacity, organisational structure, finances, patients, care processes and infrastructure, and culture). Identified gaps were synthesised into five overarching themes: education (22 studies), provision of continuity of care (21 studies), individualised management (10 studies), support for specific populations (11 studies), and research and knowledge translation (10 studies).

Conclusions: This scoping review identified health delivery gaps during a critical period in postoperative pain management. These gaps represent potential targets for quality improvement and future research to improve perioperative care and longer-term patient-centred outcomes.

Scoping review protocol: Open Science Framework (https://osf.io/cq5m6/).

Keywords: gaps in care; health delivery; pain management; persistent postsurgical pain; post-discharge; postoperative pain; transitional pain service.

Publication types

Review

MeSH terms

Adult
Delivery of Health Care
Humans
Inpatients
Pain Management*
Patient Discharge*
Systematic Reviews as Topic