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| Incidence and predictors of chronic postoperative pain in same-day surgery: A prospective cohort study |
| Melodie Fanay Boko1,2, Ashish K Khanna3,4,5, Frederick D'Aragon6, Jessica Spence7, David Conen8,9, Ameen Patel8, Sabry Ayad10, Duminda N Wijeysundera11, Manon Choinière2,12, Daniel I Sessler13, Francois Martin Carrier2,12, John Harlock14, Josèph S.H.A. Koopman15, Alparslan Turan13, Gabrielle Pagé2,12, Emmanuelle Duceppe1,2,9 1Department of Medicine, University of Montreal, Montreal, QC, Canada 2Centre de Recherche du Centre Hospitalier de l’Universite de Montreal, Montreal, QC, Canada 3Department of Anesthesiology, Wake Forest university School of Medicine, Winston-Salem, NC, United States 4Outcomes Research Consortium, Cleveland, OH, United States 5Perioperative Outcomes and Informatics Collaborative, Winston-Salem, NC, United States 6Department of Anesthesiology, University of Sherbrooke, Sherbrooke, QC, Canada 7Department of Anesthesia and Critical Care, McMaster University, Hamilton, ON, Canada 8Department of Medecine, McMaster University, Hamilton, ON, Canada 9Population Health Research Institute, Hamilton, ON, Canada 10Outcomes research, Anesthesiology institute, Cleveland Clinic - Fairview Hospital, Cleveland, OH, United States 11Department of Anesthesia, Unity Health Toronto – St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada 12Department of Anesthesiology and Pain Medicine, University of Montreal, Montreal, QC, Canada 13Department of Outcomes Research, Cleveland Clinic – Main Campus, Cleveland, OH, United States 14Department of Surgery, McMaster University, Hamilton, ON, Canada 15Department of Anesthesiology, Maasstad Hospital, Rotterdam, Netherlands |
BACKGROUND: The amount of same-day surgery has increased markedly in recent decades. Management of postoperative pain can be challenging for patients at home and poorly controlled pain may result in chronic postsurgical pain. The amount of same-day surgery has increased markedly in recent decades. Management of postoperative pain can be challenging for patients at home and poorly controlled pain may result in chronic postsurgical pain. METHODS: We assessed pain 90 days after ambulatory surgery in an international, multicentre prospective cohort study of patients ≥45 years old. Pain was assessed using the Brief Pain Inventory. Risk factors for chronic postsurgical pain were identified using multivariable logistic regression. RESULTS: A total of 2054 participants were included, and chronic postsurgical pain occurred in 12% of participants, of whom 93.1% had new chronic pain at the surgical site (i.e., participants without pain prior to surgery). Moderate to severe CPSP occurred in 9% of participants. Opioid use at 90 days was reported in 6.7% of participants, of which 48.2% were new opioid users since surgery. Independent predictors of chronic postsurgical pain were active smoking (OR 1.81; 95% CI 1.20-2.74), ethnicity (i.e., Hispanic/Latino ethnicity OR 3.41; 95% CI 1.68-6.93 and First nations/native persons OR 4.02; 95% CI 1.05-15.42), orthopaedic surgery (OR 4.59; 95% CI 2.21-9.54), plastic surgery (OR 4.30; 95% CI 2.00-9.25), breast surgery (OR 2.78; 95% CI 1.31-5.89), and vascular surgery (OR 2.66; 95% CI 1.07-6.60). CONCLUSIONS: Persistent postsurgical pain after same-day surgery is common, usually moderate to severe in nature, and occurs mostly in patients without chronic pain prior to surgery. Identifying patients at higher risk of persistent postsurgical pain and opioid use may help target preventive interventions. |