Incidence of Chronic Postsurgical Pain (CPSP) after General Surgery

• Published in: Pain medicine (Malden, Mass.) Vol. 15; no. 7; pp. 1222 - 1229
• Main Authors: Simanski, Christian J.P., Althaus, Astrid, Hoederath, Sascha, Kreutz, Kerry W., Hoederath, Petra, Lefering, Rolf, Pape‐Köhler, Carolina, Neugebauer, Edmund A.M.
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-07-2014
• Subjects: Adult; Aged; Bone surgery; Chronic Pain - epidemiology; Chronic Pain - etiology; Chronic Post‐Surgical Pain (CPSP); Cross-Sectional Studies; Female; Humans; Incidence; Male; Medical research; Middle Aged; Pain; Pain Management; Pain, Postoperative - epidemiology; Persistent Pain; Prospective Studies; Prospective Study; Risk Factors; Surgery; Surveys and Questionnaires; Wound healing; Prospective Study; Chronic Post-Surgical Pain (CPSP); Persistent Pain; Pain Management; Risk Factors
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1111/pme.12434

Objective
This study investigated the incidence and determinants of chronic postsurgical pain (CPSP) in a general surgical patient population.
Design
This is a prospective cross‐sectional study at a university‐affiliated clinic/level 1 trauma center. Patients were followed at least 1 year postoperatively. By surgical discipline, procedures were 50% orthopedic/trauma, 33% general (abdominal/visceral), and 17% vascular.
Setting
All patients admitted during one year (N = 3020) were eligible. Exclusion criteria were cognitive impairment, communication/language barrier, nonoperative treatment, and refusal to participate. A CPSP questionnaire was completed. Step‐by‐step analysis followed with a 2nd questionnaire to detect CPSP with numeric rating scale (NRS) pain intensity ≥3. Finally, individual follow‐up examinations were performed.
Results
911 patients responded (30.2%). 522 complained of pain intensity ≥3 on NRS (scale 0–10). The second step identified 214 patients with chronic pain (NRS ≥3, mean 29 months postoperatively). On final examination, 83 CPSP patients (14.8%) were identified. By surgical discipline, 28% were general, 15% vascular, and 57% trauma/orthopedic surgery. Most oftenly cited pain sites were joint (49.4%), incisional/scar (37.7%), and nerve pain (33.7%). By procedure, patients underwent pelvic surgery, colon surgery, laparoscopies, inguinal herniorrhaphies, arthroscopies, and hardware extractions. All patients in the “laborer” and “unemployed” categories reported chronic pain.
Conclusion
Bias due to study design and/or heterogeneity of patients is possible, but there was a high CPSP rate after 2 years both generally and particularly in orthopedic/trauma (57%) patients. Both “major” and “minor” surgical procedures led to CPSP.