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 sideeffects
of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β 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 lowand
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.