Procedure-specific Risk Factor Analysis for the Development of Severe Postoperative Pain

• Published in: Anesthesiology (Philadelphia) Vol. 120; no. 5; pp. 1237 - 1245
• Main Authors: Gerbershagen, Hans J, Pogatzki-Zahn, Esther, Aduckathil, Sanjay, Peelen, Linda M, Kappen, Teus H, van Wijck, Albert J M, Kalkman, Cor J, Meissner, Winfried
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Society of Anesthesiologists, Inc 01-05-2014; Lippincott Williams & Wilkins
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Factor Analysis, Statistical; Female; Humans; Male; Medical sciences; Middle Aged; Pain, Postoperative - diagnosis; Pain, Postoperative - epidemiology; Prospective Studies; Risk Factors; Severity of Illness Index; Treatment Outcome; Young Adult; Postoperative; Factor analysis; Pain; Risk factor; Anesthesia; Procedure; Risk analysis; Severe
• ISSN: 0003-3022; 1528-1175
• DOI: 10.1097/ALN.0000000000000108

BACKGROUND:Many studies have analyzed risk factors for the development of severe postoperative pain with contradictory results. To date, the association of risk factors with postoperative pain intensity among different surgical procedures has not been studied and compared.
METHODS:The authors selected precisely defined surgical groups (at least 150 patients each) from prospectively collected perioperative data from 105 German hospitals (2004–2010). The association of age, sex, and preoperative chronic pain intensity with worst postoperative pain intensity was studied with multiple linear and logistic regression analyses. Pooled data of the selected surgeries were studied with random-effect analysis.
RESULTS:Thirty surgical procedures with a total number of 22,963 patients were compared. In each surgical procedure, preoperative chronic pain intensity and younger age were associated with higher postoperative pain intensity. A linear decline of postoperative pain with age was found. Females reported more severe pain in 21 of 23 surgeries. Analysis of pooled surgical groups indicated that postoperative pain decreased by 0.28 points (95% CI, 0.26 to 0.31) on the numeric rating scale (0 to 10) per decade age increase and postoperative pain increased by 0.14 points (95% CI, 0.13 to 0.15) for each higher score on the preoperative chronic pain scale. Females reported 0.29 points (95% CI, 0.22 to 0.37) higher pain intensity.
CONCLUSIONS:Independent of the type and extent of surgery, preoperative chronic pain and younger age were associated with higher postoperative pain. Females consistently reported slightly higher pain scores regardless of the type of surgery. The clinical significance of this small sex difference has to be analyzed in future studies.