Mark Willingham1, Govind Rangrass2, Caitlin Curcuru2, Arbi Ben Abdallah1, Troy S Wildes1, Sherry McKinnon1, Alex Kronzer1, Anshuman Sharma1, Dan Helsten1, Bruce Hall3, Michael S Avidan1, Simon Haroutounian4. 1. Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, MO, USA. 2. Department of Anesthesia and Critical Care, University of Chicago Pritzker School of Medicine, Chicago, IL, USA. 3. American College of Surgeons National Surgical Quality Improvement Program, Chicago IL, USA; Department of Surgery, Washington University in St Louis, St Louis, MO, USA; BJC HealthCare, St Louis, MO, USA. 4. Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, MO, USA. Electronic address: sharout@wustl.edu.
Abstract
BACKGROUND: Post-surgical pain that lingers beyond the initial few-week period of tissue healing is a major predictor of pain chronification, which leads to substantial disability and new persistent opioid analgesic use. We investigated whether postoperative medical complications increase the risk of lingering post-surgical pain. METHODS: The study population consisted of patients undergoing diverse elective surgical procedures in an academic referral centre in the USA, between September 2013 and May 2017. Multivariable logistic regression, adjusting for confounding variables and patient-specific risk factors, was used to test for an independent association between any major postoperative complication and functionally limiting lingering pain 1-3 months after surgery, as obtained from patient self-reports. RESULTS: The cohort included 11 986 adult surgical patients; 10 562 with complete data. At least one complication (cardiovascular, respiratory, renal/gastrointestinal, wound, thrombotic, or neural) was reported by 13.3% (95% confidence interval: 12.7-14.0) of patients, and 19.7% (19.0-20.5%) reported functionally limiting lingering post-surgical pain. After adjusting for known risk factors, the patients were twice as likely (odds ratio: 2.04; 1.78-2.35) to report lingering post-surgical pain if they also self-reported a postoperative complication. Experiencing a complication was also independently predictive of lingering post-surgical pain (odds ratio: 1.95; 1.26-3.04) when complication data were extracted from the National Surgical Quality Improvement Program registry, instead of being obtained from patient self-report. CONCLUSIONS: Medical complications were associated with a two-fold increase in functionally limiting pain 1-3 months after surgery. Understanding the mechanisms that link complications to pathological persistence of pain could help develop future approaches to prevent persistent post-surgical pain.
BACKGROUND: Post-surgical pain that lingers beyond the initial few-week period of tissue healing is a major predictor of pain chronification, which leads to substantial disability and new persistent opioid analgesic use. We investigated whether postoperative medical complications increase the risk of lingering post-surgical pain. METHODS: The study population consisted of patients undergoing diverse elective surgical procedures in an academic referral centre in the USA, between September 2013 and May 2017. Multivariable logistic regression, adjusting for confounding variables and patient-specific risk factors, was used to test for an independent association between any major postoperative complication and functionally limiting lingering pain 1-3 months after surgery, as obtained from patient self-reports. RESULTS: The cohort included 11 986 adult surgical patients; 10 562 with complete data. At least one complication (cardiovascular, respiratory, renal/gastrointestinal, wound, thrombotic, or neural) was reported by 13.3% (95% confidence interval: 12.7-14.0) of patients, and 19.7% (19.0-20.5%) reported functionally limiting lingering post-surgical pain. After adjusting for known risk factors, the patients were twice as likely (odds ratio: 2.04; 1.78-2.35) to report lingering post-surgical pain if they also self-reported a postoperative complication. Experiencing a complication was also independently predictive of lingering post-surgical pain (odds ratio: 1.95; 1.26-3.04) when complication data were extracted from the National Surgical Quality Improvement Program registry, instead of being obtained from patient self-report. CONCLUSIONS: Medical complications were associated with a two-fold increase in functionally limiting pain 1-3 months after surgery. Understanding the mechanisms that link complications to pathological persistence of pain could help develop future approaches to prevent persistent post-surgical pain.
Authors: Esmee V van Helden; Allon van Uitert; Michiel C Warlé; Johan F Langenhuijsen; Kim I Albers; Monique A H Steegers; Henri J L M Timmers; Frank C H d'Ancona; Selina E I van der Wal; Gert Jan Scheffer; Christiaan Keijzer Journal: BMC Anesthesiol Date: 2022-05-19 Impact factor: 2.376
Authors: Saria S Awadalla; Victoria Winslow; Michael S Avidan; Simon Haroutounian; Thomas G Kannampallil Journal: PLoS One Date: 2022-06-10 Impact factor: 3.752
Authors: Daniel Santa Mina; Daniel Sellers; Darren Au; Shabbir M H Alibhai; Hance Clarke; Brian H Cuthbertson; Gail Darling; Alaa El Danab; Anand Govindarajan; Karim Ladha; Andrew G Matthew; Stuart McCluskey; Karen A Ng; Fayez Quereshy; Keyvan Karkouti; Ian M Randall Journal: Front Oncol Date: 2021-03-10 Impact factor: 6.244