TY - JOUR
T1 - Association between postoperative complications and lingering post-surgical pain
T2 - an observational cohort study
AU - Willingham, Mark
AU - Rangrass, Govind
AU - Curcuru, Caitlin
AU - Ben Abdallah, Arbi
AU - Wildes, Troy S.
AU - McKinnon, Sherry
AU - Kronzer, Alex
AU - Sharma, Anshuman
AU - Helsten, Dan
AU - Hall, Bruce
AU - Avidan, Michael S.
AU - Haroutounian, Simon
N1 - Publisher Copyright:
© 2019 British Journal of Anaesthesia
PY - 2020/2
Y1 - 2020/2
N2 - 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.
AB - 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.
KW - chronic post-surgical pain
KW - lingering post-surgical pain
KW - medical complications
KW - pain
KW - postoperative complications
UR - http://www.scopus.com/inward/record.url?scp=85075863577&partnerID=8YFLogxK
U2 - 10.1016/j.bja.2019.10.012
DO - 10.1016/j.bja.2019.10.012
M3 - Article
C2 - 31771788
AN - SCOPUS:85075863577
SN - 0007-0912
VL - 124
SP - 214
EP - 221
JO - British journal of anaesthesia
JF - British journal of anaesthesia
IS - 2
ER -