Hernandez–Boussard T, et al. – In this study, researchers tested their hypothesis that inpatient postoperative pain trajectories are associated with 30–day inpatient readmission and emergency department (ED) visits. Findings established the potential of postoperative pain trajectories in identifying populations at risk for 30–day readmissions and ED visits, and these were not mediated by postdischarge complications. They suggest addressing pain control expectations before discharge to reduce surgical readmissions in high pain categories.

Methods

• Researchers merged National Veterans Affairs Surgical Quality Improvement data on inpatient general, vascular, and orthopedic surgery from 2008 to 2014 with laboratory, vital sign, health care utilization, and postoperative complications data.
• They identified six distinct postoperative inpatient patient-reported pain trajectories:
• (1) persistently low,
• (2) mild,
• (3) moderate or
• (4) high trajectories, and
• (5) mild-to-low or
• (6) moderate-to-low trajectories based on postoperative pain scores.
• They used regression models to assess the association between pain trajectories and postdischarge utilization while controlling for important patient and clinical variables.

Results

• Authors included 211,231 surgeries—45.4% orthopedics, 37.0% general, and 17.6% vascular.
• Observations revealed the 30-day unplanned readmission rate of 10.8%, and 30-day ED utilization rate of 14.2%.
• In this study, patients in the high pain trajectories indicated the highest rates of postdischarge readmissions and ED visits (14.4% and 16.3%, respectively, P < 0.001).
• Multivariable models suggested that compared with the persistently low pain trajectory, there was a dose-dependent increase in postdischarge ED visits and readmission for pain-related diagnoses, but not postdischarge complications (X² trend P < 0.001).