The POPPY study is 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. It will include all adult patients who are having day case surgery (excluding overnight or 23 hour stay) requiring an anaesthetist to be present for the case. The study will not include paediatric cases, diagnostic procedures (e.g. radiology, endoscopy), minimally invasive (e.g. day case cardiology procedures), obstetric procedures and ophthalmic procedures. The study being mixed methods will involve the collection and analysis of both quantitative and qualitative data.
How this topic was chosen as the 4th RAFT national study
RAFT is a UK wide collaborative network of Trainee Research Networks (TRNs) run by trainee anaesthetists interested in research and quality improvement. TRNs are the heart and soul of RAFT, they link hospitals and work together to identify and address important research questions and areas for quality improvement. Every 2 years (bar the pandemic) RAFT aims to conduct a national study with the topic being chosen by RAFT members through a competitive process. In 2021 the idea of the POPPY study was put forward by trainees from SWARM (South West Anaesthesia Research Matrix) and against stiff competition it chosen to be the 4th RAFT project.
Why the POPPY study is important
Around 70% of all surgical procedures in the UK are day case procedures and approximately six million day-case procedures are performed each year. Although some day case units carry out next day follow up of day case patients this is not universal and increased knowledge of quality of recovery and PPSP and PPOU in the UK day case population is needed. The prevention of chronic pain has been identified as a top priority for anaesthetic research. There is growing evidence that patients undergoing day case surgery can develop long term complications including PPSP and PPOU. Large studies outside the UK have shown that PPSP and PPOU are significant issues in the day case population however data is lacking in the UK day case population.
We believe together we will be able to provide a clearer picture on patients’ experience of recovery from day surgery, rates of persistent post surgical pain and persistent postoperative opiate use in the UK. We also hope to describe associated risk and protective factors for poor post surgical outcomes following day surgery. We have involved patient representatives in all stages of planning POPPY to ensure that the research aims are relevant to patients. We will continue to have this invaluable patient and public involvement and engagement group (PPIE) input throughout the study.
POPPY's primary objectives are:
to measure the quality of recovery in the UK day case surgical population during the first postoperative week
to measure the prevalence of persistent post surgical pain (PPSP) and persistent postoperative opioid use (PPOU) in the UK day case surgical population
Secondary objectives include:
identify the characteristics that are associated with poor quality of recovery and the development of PPSP and PPOU
describe the prevalence of acute pain and analgesia use during the first postoperative week
investigate the differences in quality of life between patients with and without PPSP
describe the patient reported acceptability of SMS prompted long term follow-up in observational studies in anaesthesia
The aims of the qualitative part of the study are to explore the patient experience of day case surgery, acute recovery, longer term recovery and opioid use in patients experiencing PPSP.
What taking part with POPPY means for study sites
During the 5 day study period teams at hospital sites involved with POPPY will be responsible for activities on the day patients’ operations. These activities will be:
assessing eligibility of day case patients
recruiting and consenting patients
collecting baseline patient data on the day of surgery and inputing this on the online NewcastlePROMS data secure system
All subsequent follow up including the qualitative portion of the study will be managed by the central POPPY study team. Patients will be followed up postoperatively on days 1, 3, 7 & 97 via SMS or e-mail (depending on patient preference) with a link to online data secure questionnaires. At each point of contact all study participants will be given the option to withdraw from the study.
Local sites will be responsible for contacting participants GPs if they have PPSP and are flagged as scoring highly on depression and anxiety scores. Sites research teams will get an alert on the Newcastle PROMs POPPY platform as to which participants this applies to. A draft GP letter can be found under study documents.
All members of local teams will need to have an up to date GCP certificate. As with previous RAFT projects teams made up of several local collaborators will work together over the study period to ensure that all eligible patients are offered the opportunity to be involved with POPPY.
Is SMS/e-mail follow up used for POPPY secure?
NewcastlePROMS (https://newcastleproms.co.uk/) is a secure online system already used in UK NHS centres for next day day-case follow up. It combines a system for researcher baseline data entry and a system for automated SMS-prompted patient data entry. It meets all necessary data protection and security requirements mandated for management of study data in the UK health service. A major advantage is its bespoke patient-facing system which is being designed in collaboration with the central study team and our patient and public involvement and engagement group. NewcastlePROMS has already been used successfully for postoperative feedback in multiple UK NHS hospitals. If we are able to demonstrate its efficacy with POPPY this will have great implications for future trainee led research projects.
Will SMS/e-mail follow up used for POPPY work?
We think so! In 2021 in the UK >95% of people under 55 years of age had access to a smart phone with 90% of people between 55-64 years and 69% of people >65 years. Mobile phone ownership is growing especially in those over 65 years where there is around 5% growth per year. We also anticipate that patients’ without a smartphone may well have access to one e.g. through their spouse or family members. For those without access to mobile phones follow up can be done via e-mail. ONS data in 2020 showed that 96% of households in Great Britain have access to the internet. If we are able to demonstrate SMS/e-mail follow up efficacy with POPPY this will have great implications for future trainee led research projects.
If you have any questions about POPPY please get in touch