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POPPY (RAFT 4)
POPPY (RAFT 4)
Patient reported outcomes, postoperative pain and pain relief after day case surgery
Patient reported outcomes, postoperative pain and pain relief after day case surgery
RAFT - Research and Audit Federation of Anaesthetists in Training
RAFT - Research and Audit Federation of Anaesthetists in Training
Chief Investigator: Dr Mark Rockett
The POPPY study was a national trainee led prospective multi-centre mixed methods observational cohort study investigating patient reported outcomes in quality of recovery, postoperative pain and pain relief in adults undergoing day case surgery in the UK, between June 2023 and August 2024. It included all adult patients who are having day case surgery (excluding overnight or 23 hour stay) requiring an anaesthetist to be present for the case.
Primary objectives
To measure short and long-term patient reported outcomes in UK day-case surgery patients in relation to recovery, post-surgical pain and opiate use.
To describe the quality of recovery over the first postoperative week
To establish the prevalence of persistent postsurgical pain (PPSP) and persistent postoperative opioid use (PPOU) in day case surgical patients.
Secondary objectives
To conduct a pilot study over 4 hospital sites to confirm the feasibility of the large-scale multi-centre study
To identify those patient, medication, anaesthetic, and surgical characteristics that are associated with poor quality of recovery, and PPSP and/or PPOU
To describe the acute pain experience and analgesia use in the first postoperative week
To estimate the need for further healthcare support in the first postoperative week
To determine the patient reported acceptability of SMS prompted follow-up
To determine the difference in quality of life between participants with and without PPSP
To investigate the difficulty in reducing opioid use in participants with PPOU
You can find more information here.
Summary of results
Summary of results
The prospective POPPY study recruited 9618 patients across 199 UK sites, with 7839 remaining after exclusions.
Unplanned inpatient admission occurred in 1131/9618 patients (11.8%), and was more common with greater frailty, higher ASA physical status and increasing surgical magnitude.
Admission rates exceeded the cited national targets, occurring after 6.6% of minor, 10.8% of intermediate and 19.4% of major procedures. Rates reached 22.4% for laparoscopic cholecystectomy and 58% for TURP.
Pre-existing pain was common, with 39% reporting pain at the planned surgical site; 30.5% of the cohort had chronic pain there, lasting over three months. Chronic pain elsewhere was reported by 32.5%.
One in nine patients used opioids daily before surgery, with 11.3% reporting at least daily use, including 2.1% taking strong opioids. Overall, 25.3% had access to opioid medication.
Mental health difficulties were frequent, with 14.1% receiving treatment for depression and 13.3% for anxiety. Moderate or worse anxiety/depression was reported by 12.8% on the EQ-5D-5L questionnaire.
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