Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study

Author:

Khan James S.1,Sessler Daniel I.2,Chan Matthew T. V.3,Wang C. Y.4,Garutti Ignacio5,Szczeklik Wojciech6,Turan Alparslan7,Busse Jason W.8,Buckley D. Norman9,Paul James8,McGillion Michael10,Fernández-Riveira Carmen6,Srinathan Sadeesh K.11,Shanthanna Harsha8,Gilron Ian12,Jacka Michael13,Jackson Paul8,Hankinson James8,Paniagua Pilar14,Pettit Shirley11,Devereaux P. J.15

Affiliation:

1. From the Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada

2. the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio

3. the Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China

4. the Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

5. the Department of Anesthesiology and Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain; the Department of Medicine and Pharmacology, Complutense University of Madrid, Madrid, Spain

6. the Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland

7. the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio; the Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio

8. the Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada

9. the Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; the Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada

10. the School of Nursing, McMaster University, Hamilton, Ontario, Canada; the Population Health Research Institute, Hamilton, Ontario, Canada

11. the Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada

12. the Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston, Ontario, Canada

13. the Department of Critical Care, School of Medicine, University of Alberta, Edmonton, Alberta, Canada

14. the Biomedical Research Institute Sant Pau, Barcelona, Spain

15. the Departments of Health Research Methods, McMaster University, Hamilton, Ontario, Canada; Medicine, McMaster University, Hamilton, Ontario, Canada; the Population Health Research Institute, Hamilton, Ontario, Canada

Abstract

Background The purpose of this study was to determine the incidence, characteristics, impact, and risk factors associated with persistent incisional pain. The hypothesis was that patient demographics and perioperative interventions are associated with persistent pain. Methods This was a secondary analysis of an international prospective cohort study from 2012 to 2014. This study included patients who were 45 yr of age or older who underwent major inpatient noncardiac surgery. Data were collected perioperatively and at 1 yr after surgery to assess for the development of persistent incisional pain (pain present around incision at 1 yr after surgery). Results Among 14,831 patients, 495 (3.3%; 95% CI, 3.1 to 3.6) reported persistent incisional pain at 1 yr, with an average pain intensity of 3.6 ± 2.5 (0 to 10 numeric rating scale), with 35% and 14% reporting moderate and severe pain intensities, respectively. More than half of patients with persistent pain reported needing analgesic medications, and 85% reported interference with daily activities (denominator = 495 in the above proportions). Risk factors for persistent pain included female sex (P = 0.007), Asian ethnicity (P < 0.001), surgery for fracture (P < 0.001), history of chronic pain (P < 0.001), coronary artery disease (P < 0.001), history of tobacco use (P = 0.048), postoperative patient-controlled analgesia (P < 0.001), postoperative continuous nerve block (P = 0.010), insulin initiation within 24 h of surgery (P < 0.001), and withholding nonsteroidal anti-inflammatory medication or cyclooxygenase-2 inhibitors on the day of surgery (P = 0.029 and P < 0.001, respectively). Older age (P < 0.001), endoscopic surgery (P = 0.005), and South Asian (P < 0.001), Native American/Australian (P = 0.004), and Latin/Hispanic ethnicities (P < 0.001) were associated with a lower risk of persistent pain. Conclusions Persistent incisional pain is a common complication of inpatient noncardiac surgery, occurring in approximately 1 in 30 adults. It results in significant morbidity, interferes with daily living, and is associated with persistent analgesic consumption. Certain demographics, ethnicities, and perioperative practices are associated with increased risk of persistent pain. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Anesthesiology and Pain Medicine

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