Persistent incisional pain after noncardiac surgery: An international prospective cohort study

Khan, James S. and Sessler, Daniel I. and Chan, Matthew T. V. and Wang, Chew Yin and Garutti, Ignacio and Szczeklik, Wojciech and Turan, Alparslan and Busse, Jason W. and Buckley, D. Norman and Paul, James and McGillion, Michael and Fernandez-Riveira, Carmen and Srinathan, Sadeesh K. and Shanthanna, Harsha and Gilron, Ian and Jacka, Michael and Jackson, Paul and Hankinson, James and Paniagua, Pilar and Pettit, Shirley and Devereaux, P. J. (2021) Persistent incisional pain after noncardiac surgery: An international prospective cohort study. Anesthesiology, 135 (4). pp. 711-723. ISSN 0003-3022, DOI

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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.

Item Type: Article
Funders: 50 grants for VISION, Canadian Institutes of Health Research (CIHR), Heart & Stroke Foundation of Ontario, Academic Health Science Centers Alternative Funding Plan Innovation Fund grant (Hamilton, Ontario,Canada), Population Health Research Institute (Hamilton, Ontario, Canada), Clarity Research Group grant (Hamilton, Ontario, Canada), McMaster University Department of Surgery Surgical Associates, Hamilton Health Science New Investigator Fund grant (Hamilton, Ontario, Canada), Hamilton Health Sciences grant (Hamilton, Ontario, Canada), Ontario Ministry of Resource and Innovation grant (Toronto, Ontario, Canada), Stryker Canada (Waterdown, Ontario, Canada), McMaster University Department of Anesthesiology, St. Joseph's Healthcare Department of Medicine (Hamilton, Ontario, Canada), Father Sean O'Sullivan Research Center (Hamilton, Ontario, Canada), McMaster University Department of Medicine, six summer, Hamilton Health Sciences, a McMaster University Department of Clinical Epidemiology and Biostatistics grant, McMaster University Division of Cardiology Grant, Canadian Network and Center for Trials (Halifax, Nova Scotia, Canada), Winnipeg Health Sciences Foundation operating grant (Winnipeg, Manitoba, Canada), Diagnostic Services of Manitoba research grant (Winnipeg, Manitoba, Canada), University of Manitoba Faculty of Dentistry Operational Fund grant (Winnipeg, Manitoba, Canada), Projeto Hospitais de Excelencia a Servico do SUS grant from the Brazilian Ministry of Health in Partnership with the Cardiac Hospital Sao Paulo-SP (Sao Paulo, Brazil), School of Nursing at the Universidad Industrial de Santander (Santander, Colombia), Grupo de Cardiologia Preventiva, a grant from the Universidad Autonoma de Bucaramanga (Santander, Colombia), Fundacion Cardioinfantil Instituto de Cardiologia (Bogota, Colombia), Alianza Diagnostica SA (Santander, Colombia), University of Malaya (Kuala Lumpur, Malaysia) Research grant [RG196/10HTM], University of Malaya Penyelidikan Jangka Pendek Grant, Public Policy Research Fund grant [CUHK-4002-PPR-3], General Research Fund from the Research Grant Council, Hong Kong SAR (Hong Kong, China) [461412], New Zealand College of Anaesthetists (Melbourne, Australia) [13/008], Canadian Institutes of Health Research (CIHR)
Uncontrolled Keywords: Chronic post; Surgical pain; Ethnic-differences; Prevalence; Association; Responses; Impact; Time
Subjects: R Medicine > RD Surgery
Divisions: Faculty of Medicine > Anaesthesiology Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 12 Sep 2022 00:42
Last Modified: 12 Sep 2022 00:42

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