Persistent incisional pain after noncardiac surgery: An international prospective cohort study
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...
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my.um.eprints.346212022-09-12T00:42:58Z http://eprints.um.edu.my/34621/ Persistent incisional pain after noncardiac surgery: An international prospective cohort study Khan, James S. Sessler, Daniel I. Chan, Matthew T. V. Wang, Chew Yin Garutti, Ignacio Szczeklik, Wojciech Turan, Alparslan Busse, Jason W. Buckley, D. Norman Paul, James McGillion, Michael Fernandez-Riveira, Carmen Srinathan, Sadeesh K. Shanthanna, Harsha Gilron, Ian Jacka, Michael Jackson, Paul Hankinson, James Paniagua, Pilar Pettit, Shirley Devereaux, P. J. RD Surgery 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. Lippincott Williams & Wilkins 2021-10 Article PeerReviewed 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 https://doi.org/10.1097/ALN.0000000000003951 <https://doi.org/10.1097/ALN.0000000000003951>. 10.1097/ALN.0000000000003951 |
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RD Surgery Khan, James S. Sessler, Daniel I. Chan, Matthew T. V. Wang, Chew Yin Garutti, Ignacio Szczeklik, Wojciech Turan, Alparslan Busse, Jason W. Buckley, D. Norman Paul, James McGillion, Michael Fernandez-Riveira, Carmen Srinathan, Sadeesh K. Shanthanna, Harsha Gilron, Ian Jacka, Michael Jackson, Paul Hankinson, James Paniagua, Pilar Pettit, Shirley Devereaux, P. J. Persistent incisional pain after noncardiac surgery: An international prospective cohort study |
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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. |
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Article |
author |
Khan, James S. Sessler, Daniel I. Chan, Matthew T. V. Wang, Chew Yin Garutti, Ignacio Szczeklik, Wojciech Turan, Alparslan Busse, Jason W. Buckley, D. Norman Paul, James McGillion, Michael Fernandez-Riveira, Carmen Srinathan, Sadeesh K. Shanthanna, Harsha Gilron, Ian Jacka, Michael Jackson, Paul Hankinson, James Paniagua, Pilar Pettit, Shirley Devereaux, P. J. |
author_facet |
Khan, James S. Sessler, Daniel I. Chan, Matthew T. V. Wang, Chew Yin Garutti, Ignacio Szczeklik, Wojciech Turan, Alparslan Busse, Jason W. Buckley, D. Norman Paul, James McGillion, Michael Fernandez-Riveira, Carmen Srinathan, Sadeesh K. Shanthanna, Harsha Gilron, Ian Jacka, Michael Jackson, Paul Hankinson, James Paniagua, Pilar Pettit, Shirley Devereaux, P. J. |
author_sort |
Khan, James S. |
title |
Persistent incisional pain after noncardiac surgery: An international prospective cohort study |
title_short |
Persistent incisional pain after noncardiac surgery: An international prospective cohort study |
title_full |
Persistent incisional pain after noncardiac surgery: An international prospective cohort study |
title_fullStr |
Persistent incisional pain after noncardiac surgery: An international prospective cohort study |
title_full_unstemmed |
Persistent incisional pain after noncardiac surgery: An international prospective cohort study |
title_sort |
persistent incisional pain after noncardiac surgery: an international prospective cohort study |
publisher |
Lippincott Williams & Wilkins |
publishDate |
2021 |
url |
http://eprints.um.edu.my/34621/ |
_version_ |
1744649190006325248 |