TY - JOUR
T1 - Perioperative factors associated with persistent postsurgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy
T2 - A systematic review and meta-analysis
AU - Sharma, Lokesh R.
AU - Schaldemose, Ellen Lund
AU - Alaverdyan, Harutyun
AU - Nikolajsen, Lone
AU - Chen, DIli
AU - Bhanvadia, Shivam
AU - Komen, Helga
AU - Yaeger, Lauren
AU - Haroutounian, Simon
N1 - Funding Information:
S. Haroutounian has received research support from Disarm therapeutics and consulting fees from Medoc Ltd and Rafa Laboratories. The remaining authors have no conflicts of interest to declare.
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Persistent postsurgical pain (PPSP) is a common and often disabling postoperative morbidity, but many questions remain about factors associated with PPSP. This systematic review and meta-analysis aimed to identify preoperative, intraoperative, and postoperative factors associated with PPSP after gynecological surgeries, namely, hysterectomy and cesarean section, and urological surgeries, namely, prostatectomy and donor nephrectomy. Overall, 18 gynecological surgery studies, 4 prostatectomy studies, and 2 donor nephrectomy studies met the review criteria, providing data that could be meta-analyzed. The average (±SD) PPSP occurrence after gynecological surgery was 20 ± 11%; factors associated with increased risk of PPSP included smoking, preoperative abdominal or pelvic pain, preoperative pain elsewhere in the body, longer duration of surgery, more intense acute postoperative pain, and surgical wound infection. The use of neuraxial anesthesia was associated with decreased PPSP risk. The average PPSP occurrence was 20 ± 9% after prostatectomy and 15 ± 2% after donor nephrectomy. For urological procedures, the existing data did not allow for identification of significant factors associated with PPSP, except for laparoscopic and hand-assisted laparoscopic approaches that were associated with lower incidence of PPSP for donor nephrectomy, and the use of neuraxial anesthesia which was associated with lower incidence of PPSP after prostatectomy. Persistent postsurgical pain after gynecological and urological surgeries is common. This systematic review identified important factors associated with cesarean section and hysterectomy that can help identify women who are at high risk of PPSP. More high-quality studies with consistent methodology are needed to understand the factors associated with PPSP risk, particularly for surgeries such as prostatectomy and nephrectomy.
AB - Persistent postsurgical pain (PPSP) is a common and often disabling postoperative morbidity, but many questions remain about factors associated with PPSP. This systematic review and meta-analysis aimed to identify preoperative, intraoperative, and postoperative factors associated with PPSP after gynecological surgeries, namely, hysterectomy and cesarean section, and urological surgeries, namely, prostatectomy and donor nephrectomy. Overall, 18 gynecological surgery studies, 4 prostatectomy studies, and 2 donor nephrectomy studies met the review criteria, providing data that could be meta-analyzed. The average (±SD) PPSP occurrence after gynecological surgery was 20 ± 11%; factors associated with increased risk of PPSP included smoking, preoperative abdominal or pelvic pain, preoperative pain elsewhere in the body, longer duration of surgery, more intense acute postoperative pain, and surgical wound infection. The use of neuraxial anesthesia was associated with decreased PPSP risk. The average PPSP occurrence was 20 ± 9% after prostatectomy and 15 ± 2% after donor nephrectomy. For urological procedures, the existing data did not allow for identification of significant factors associated with PPSP, except for laparoscopic and hand-assisted laparoscopic approaches that were associated with lower incidence of PPSP for donor nephrectomy, and the use of neuraxial anesthesia which was associated with lower incidence of PPSP after prostatectomy. Persistent postsurgical pain after gynecological and urological surgeries is common. This systematic review identified important factors associated with cesarean section and hysterectomy that can help identify women who are at high risk of PPSP. More high-quality studies with consistent methodology are needed to understand the factors associated with PPSP risk, particularly for surgeries such as prostatectomy and nephrectomy.
KW - Cesarean Section
KW - Chronic pain
KW - Hysterectomy
KW - Meta-analysis
KW - Nephrectomy
KW - Persistent postsurgical pain
KW - Postoperative pain
KW - Prostatectomy
KW - Risk factors
KW - Systematic review
UR - http://www.scopus.com/inward/record.url?scp=85124576632&partnerID=8YFLogxK
U2 - 10.1097/j.pain.0000000000002361
DO - 10.1097/j.pain.0000000000002361
M3 - Review article
C2 - 34121077
AN - SCOPUS:85124576632
SN - 0304-3959
VL - 163
SP - 425
EP - 435
JO - Pain
JF - Pain
IS - 3
ER -