Predictors of postdischarge pain outcomes after colorectal surgery: A prospective cohort study.
Bibliographic record
Abstract
Background: Post-discharge pain management after colorectal surgery is challenging due to the multifactorial nature of pain and the risks of adverse events. Identifying modifiable factors associated with pain outcomes may help optimize care. The study reported in this thesis aimed to assess the extent to which patient and care-related factors impact 7-day post-discharge pain outcomes after colorectal surgery.Methods: This cohort study included adult patients undergoing elective colorectal surgery at two university-affiliated hospitals in Canada. Preoperative assessments included demographics, Pain Catastrophizing Scale, and PROMIS-29 anxiety and depression scales. 7-day post-discharge pain outcomes included PROMIS-29 pain intensity (range 0–10), pain interference (41.6–75.6), and satisfaction with pain management (high [10–9] vs. lower [8–0]). The association of potential predictors with pain outcomes was evaluated using Bayesian Model Averaging, with higher posterior effect probability (PEP) reflecting stronger evidence of association.Results: 347 patients were included (59±15 years, 53% male, 64% laparoscopic, 31% rectal resection, length of stay 3 days [IQR 2-5], same-day discharge 18%). At 7 days post-discharge, the median patient-reported pain intensity was 3/10 [IQR 1-4], pain interference was 58 [IQR 54–65], and 38% of patients reported lower satisfaction with pain management. Preoperative chronic pain (>3 months) was associated with increased pain intensity (β 0.68, PEP=78%) and lower satisfaction with pain management (OR 1.72, PEP=75%). Younger age (β -0.10, PEP=98%), same-day discharge (β 3.6, PEP=86%), and preoperative anxiety (β 0.13, PEP=71%) were associated with increased pain interference. The use of the transversus abdominis plane (TAP) block decreased the likelihood of lower satisfaction (OR 0.7, PEP=52%). Conclusion: In this study, post-discharge pain outcomes after colorectal surgery were generally positive, and influenced by an interplay of demographic, clinical, emotional, and care-related factors. These findings provide valuable insights to inform multifaceted strategies to improve pain outcomes and enhance patient experiences
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".