Genetic risk factors for chronic postsurgical pain in children: A narrative review.

Genetic risk factors for chronic postsurgical pain in adults have been established, but little is known whether the same associations exist in children. It is even less clear how much influence single nucleotide polymorphisms can exert on the phenotypic expression of chronic postsurgical pain in children in general. To this effect, a search was made for original articles which met the following criteria: evaluation of postsurgical pain in children with known genetic mutations or, conversely, evaluation of atypical pain trajectories of postsurgical children assessing for possible genetic mutations that may explain the phenotype. All titles and abstracts retrieved were reviewed for suitability for inclusion. The references of the selected articles were also checked for additional relevant papers. To assess the transparency and quality of the genetic studies both STrengthening the REporting of Genetic Association studies scores and Q-Genie scores were applied. Overall, there is a paucity of information regarding the link between genetic mutations and eventual chronic postsurgical pain development although there is some information on acute postoperative pain. Evidence has shown that the contribution of genetic risk factors to chronic postsurgical pain development appears to be minor, with its clinical relevance yet to be described. More advanced techniques in systems biology (proteomics, transcriptomics) suggest promising avenues for investigating the disease.

Optimizing discharge decision-making in colorectal surgery: a prospective cohort study of discharge practices in a recently implemented enhanced recovery pathway.

AIM: The objectives of this project were (1) to compare time to readiness for discharge by set criteria and actual length of stay (LOS) in a newly implemented colorectal enhanced recovery pathway and (2) to identify reasons for delayed hospital discharge. METHOD: We conducted a prospective cohort study of 73 adult patients (age 67 ± 14 years, 56% men, 51% laparoscopic, 13% stoma creation) undergoing elective colorectal surgery in a university hospital with a recently implemented recovery pathway (<2 years). Time to readiness for discharge (oral intake, flatus, pain control, ability to walk, and no complications) was compared to actual LOS using a correlation-adjusted log-rank test. The treating team was interviewed, and thematic analysis was used to identify reasons for patients remaining in hospital after discharge criteria (DC) were achieved. RESULTS: Median LOS was 6 (4-8) days and median time to readiness for discharge was 5 (3-8) days (P < 0.001). Twenty-eight patients (37%) remained in hospital after DC were achieved. Although some delayed discharges were medically justified (e.g., workup [13%] or treatment of complications not captured by DC [2.6%]), unnecessary hospital stays were common (e.g., perceived need for observation [16%], or patients not willing to be discharged [11%]). CONCLUSIONS: Unnecessary hospital stays were common within a recently implemented enhanced recovery pathway and represent a target for quality improvement. Efforts should be directed at optimizing patient education regarding discharge expectations, early consultation of the discharge planning team and improving discharge decision-making using standardized DC.