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Persistent Incisional Pain after Noncardiac Surgery: An International Prospective Cohort Study

Khan JS 1 , Sessler DI 2 , Chan MTV 3 , Wang CY 4 , Garutti I 5 , Szczeklik W 6 Show all authors , Turan A 7 , Busse JW 8 , Buckley DN 9 , Paul J 8 , McGillion M 10 , Fernández-Riveira C 6 , Srinathan SK 11 , Shanthanna H 8 , Gilron I 12 , Jacka M 13 , Jackson P 8 , Hankinson J 8 , Paniagua P 14 , Pettit S 11 , Devereaux PJ 15

Affiliations 

  • 1 From the Department of Anesthesia and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
  • 2 the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
  • 3 the Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
  • 4 the Department of Anaesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 5 the Department of Anesthesiology and Critical Care, Hospital General Universitario Gregorio Marañón, Madrid, Spain; the Department of Medicine and Pharmacology, Complutense University of Madrid, Madrid, Spain
  • 6 the Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
  • 7 the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio; the Department of General Anesthesia, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
  • 8 the Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
  • 9 the Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; the Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
  • 10 the School of Nursing, McMaster University, Hamilton, Ontario, Canada; the Population Health Research Institute, Hamilton, Ontario, Canada
  • 11 the Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
  • 12 the Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
  • 13 the Department of Critical Care, School of Medicine, University of Alberta, Edmonton, Alberta, Canada
  • 14 the Biomedical Research Institute Sant Pau, Barcelona, Spain
  • 15 the Departments of Health Research Methods, McMaster University, Hamilton, Ontario, Canada; Medicine, McMaster University, Hamilton, Ontario, Canada; the Population Health Research Institute, Hamilton, Ontario, Canada
Anesthesiology, 2021 10 01;135(4):711-723.
PMID: 34499129 DOI: 10.1097/ALN.0000000000003951

Abstract

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.

EDITOR’S PERSPECTIVE:

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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