Delphi study to develop a core outcome set for inpatient pain assessment after cesarean delivery

BACKGROUND: Studies of cesarean delivery pain report different outcomes, restricting data pooling. This study aimed to develop a core outcome set for inpatient postoperative pain assessment after cesarean delivery to use for research and clinical practice, using the Delphi consensus methodology.

METHODS: A scoping review identified 37 initial outcomes, with 2 additional outcomes developed from a patient focus group. These were rated in a two-round Delphi survey process completed by a panel consisting of authors of studies identified from a scoping review (n = 9), supplemented with other experts (n = 5) and patients with recent lived experience of post cesarean delivery pain (n = 7). Scores were collected usinga 1-5 Likert scale, 1-2 being 'critical for inclusion'; 3 being 'important but not critical', and 4-5 of 'limited importance/invalid'. Outcomes were included if recommended by ≥70% of stakeholders after voting. A third-round virtual meeting determined domains, and several further rounds of online surveys finalizedthe specific measures.

RESULTS: Round one included 14 experts and 7 patients (100% response). Round two included 12 experts and 4 patients (76% response). The virtual meeting was attended by 11 experts and 3 patients (67%), and the 4 online surveys were completed by 67%, 52%, 67%, and 76%. The final domains included pain intensity: at rest, movement-evoked, and pain relief; pain interference; total consumption of opioids; and maternal adverse effects. 12 measures for domains were agreed upon. Getting out of a hospital bed was selected as the most relevant functional activity for movement-evoked pain after cesarean delivery.

CONCLUSIONS: This core outcome set may be applied to future research and clinical practice initiatives to evaluate post cesarean delivery pain.