Title: 
The comparison of postoperative pain severity in different types of hospitals in the eastern Poland
Aims and goals
Pain assessment and treatment still does not cover all patients requirements. Many patients suffer from severe pain in postoperative period. 
The main goal of the study was the assessment of pain severity among patients from different types of hospitals (primary, secondary and tertiary centers) in the similar types of surgeries.The other goals were if there was any difference in pain severity associated with anaesthesia techniques and type of surgery.

Methods: 
The prospective,  observational study. The VAS (visual-analogue scale) was used to measure pain severity 4 times on the day of surgery ( at 0-4, 4-8, 8-12, 24 hour). Demographic data, a types of hospital, surgery and anaesthesia were also collected. 
Only adults who were able to note their pain severity participated in the study.  VAS was not received from the patients anesthetized under local technique with or without sedation.  
The analysis of variances  (ANOVA) and t-test were used to assess the statistics. Contingency tables were utilized for demographics. All measurements were done with Statistica 12.5(  Stat Soft. Inc., Tulsa, USA)

Results:
The study was conducted from November 2015 to June 2016 in 7 hospitals in the south-eastern Poland : 2 university, 2 secondary and 3 primary hospitals. VAS forms were collected from 565 patients . Three form were excluded (local anaesthesia). 
269 women and 293 men participated in the study. The mean age was 51.73 (50.37-53.11)years, 52.78 (50.95-54,61)years for females, and 50.78 (48.76-52.81) years for males. The average weight and height for women participating in the study was 71.82 (69.93-73.73) kg and 162.42 ( 161.10-163.74) cm. Subsequently in male population  it was  82.68 (80.54-84.82) kg and 174.10 (173.06-175.14)cm.
The number of patients from tertiary hospitals was 284, from secondary hospitals 154 and primary ones was 124. There was no statistical difference in general VAS value between types of hospitals. The average values of VAS: tertiary hospitals 29.49 (27.43-31.54), secondary hospitals 28.87 (26.08-31.66) and primary hospitals 30.02 (26.91-33.13); F=0.149, p=0.861.
However, there was a significant difference between primary and secondary hospitals at 4 hour (F=7,32, p=0.000727). 0-4 VAS values: primary hospitals 40.25 (35.62-44.88), secondary hospitals 28.12 (24.02-32.34). Moreover,  the difference was found between primary hospitals  and both secondary and tertiary hospitals (F=7.29, p=0.000745). The mean 8-12 VAS values were: primary hospitals 20.37 (16.34-24.39), secondary hospitals 30.62 (27.0-34.23), tertiary hospitals 27.73 (25.06-30.38).
According to the operated region, there was a significant difference at 4 hour between lower limb surgery and the epigastric region and chest surgeries (F=5.77, p=0.000033). 0-4 VAS values: lower limb 23.68 (18.20- 29.15), chest  41.35 (36.82-45.89), epigastrium 42.70 (34.30-51.10).
At 8-12 hour after surgery there was a significant difference between chest and lower limb surgeries (F= 4.28, p=0,00079). VAS values: chest 21.18 (17.21-25.15), lower limb 31.28 (26.49-36.08). 
At 24 hour there was a significant difference between lower limb and either head and neck or epigastrium surgeries.  (F=5.62, p= 0,000046). 24 hour VAS: lower limb 31.95 (27.69-36.21), head and neck 19.43 (15.53-23.32), epigastrium 26.48 (19.95-33.02).
There was only found a significant difference between general and subarachnoid types of anaesthesia at 4 hour (F=6.53, p=0,0000002). The VAS values: general  39.41 (36.66-42.17), subarachnoid 25.47 (20.68-30.26). 

Conclusions: the type of hospital may influence patients’ pain severity, but more research needs to be done.