An Updated Systematic Review and Consensus Definitions for Standardised Endpoints in Perioperative Medicine: Patient Comfort and Pain Relief

Authors

• Paul S Myles
• Sophie Wallace
• Oliver Boney
• Mari Botti
• Frances Chung
• Allan M Cyna
• Tong J Gan
• Michael P W Grocott
• Mark P Jensen
• Henrik Kehlet
• Andrea Kurz
• Maxime Leger
• Ulrica Nilsson
• Phillip Peyton
• Daniel I Sessler
• Martin R Tramèr
• Christopher L Wu
• Alfred Health Patient Experience and Consumer Engagement Group

Language

English

Publication Date

5-1-2025

Journal

British Journal of Anaesthesia

DOI

10.1016/j.bja.2025.02.025

PMID

40133111

Abstract

Background: Improving comfort during and after surgery is a key concern for anaesthetists and other clinicians. With the inclusion of patient and public involvement, we undertook a Delphi consensus process to update previously recommended endpoints to be used in clinical trials evaluating treatments aiming to improve patient comfort after surgery.

Methods: We undertook a systematic review to identify domains and outcome measures of patient comfort used in perioperative studies. Focus groups, workshops, and a multi-round Delphi consensus process that included clinician-researchers and a patient experience and consumer group updated a recommended list of standardised endpoints focused on patient comfort. Consensus was defined as a median item score of 7 or greater and at least 70% of responses achieving a score of 7 or greater on a 9-point Likert scale. Additional ratings were done to determine validity, reliability, feasibility, and patient-centredness. Qualitative analyses were undertaken to identify themes.

Results: Response rates for each of the Delphi rounds were 100%. A final list of eight defined endpoints was identified: supplementary analgesic use, subjective analgesic effectiveness, pain intensity (at rest, during movement, and at 12, 24, and 72 h), postoperative nausea and vomiting (PONV, at 0-6 h, at 6-24 h, and overall), postdischarge nausea and vomiting (PDNV), severe PONV, quality of recovery (QoR-15), and time to mobilisation. All endpoints were assessed as valid, reliable, and feasible measures of patient comfort and were considered patient-centred. Patient and public involvement highlighted the importance of clear communication and shared decision-making to enhance comfort through the surgical journey.

Conclusions: We recommend that at least some of these standardised endpoints be included as outcome measures in clinical trials assessing patient comfort and pain after surgery.

Systematic review protocol: Open Science Framework (10.17605/OSF.IO/DJQFE).

Keywords

Humans, Delphi Technique, Patient Comfort, Postoperative Pain, Pain Management, Perioperative Medicine, Endpoint Determination, Perioperative Care, Pain Measurement, Postoperative Nausea and Vomiting, Delphi, analgesia, clinical trials, nausea, patient experience, patient-reported outcomes, postoperative pain, vomiting

Published Open-Access

yes

Recommended Citation

Myles, Paul S; Wallace, Sophie; Boney, Oliver; et al., "An Updated Systematic Review and Consensus Definitions for Standardised Endpoints in Perioperative Medicine: Patient Comfort and Pain Relief" (2025). Faculty, Staff and Student Publications. 1523.
https://digitalcommons.library.tmc.edu/uthsph_docs/1523