Effect of acute postsurgical pain trajectories on 30-day and 1-year pain

Abstract

Untreated pain after surgery leads to poor patient satisfaction, longer hospital length of stay, lower health-related quality of life, and non-compliance with rehabilitation regimens. The aim of this study is to characterize the structure of acute pain trajectories during the postsurgical hospitalization period and quantify their association with pain at 30-days and 1-year after surgery. This cohort study included 2106 adult (≥18 years) surgical patients who consented to participate in the SATISFY-SOS registry (February 1, 2015 to September 30, 2017). Patients were excluded if they did not undergo invasive surgeries, were classified as outpatients, failed to complete follow up assessments at 30-days and 1-year following surgery, had greater than 4-days of inpatient stay, and/or recorded fewer than four pain scores during their acute hospitalization period. The primary exposure was the acute postsurgical pain trajectories identified by a machine learning-based latent class approach using patient-reported pain scores. Clinically meaningful pain (≥3 on a 0–10 scale) at 30-days and 1-year after surgery were the primary and secondary outcomes, respectively. Of the study participants (N = 2106), 59% were female, 91% were non-Hispanic White, and the mean (SD) age was 62 (13) years; 41% of patients underwent orthopedic surgery and 88% received general anesthesia. Four acute pain trajectory clusters were identified. Pain trajectories were significantly associated with clinically meaningful pain at 30-days (p = 0.007), but not at 1-year (p = 0.79) after surgery using covariate-adjusted logistic regression models. Compared to Cluster 1, the other clusters had lower statistically significant odds of having pain at 30-days after surgery (Cluster 2: [OR = 0.67, 95%CI (0.51–0.89)]; Cluster 3:[OR = 0.74, 95%CI (0.56–0.99)]; Cluster 4:[OR = 0.46, 95%CI (0.26–0.82)], all p<0.05). Patients in Cluster 1 had the highest cumulative likelihood of pain and pain intensity during the latter half of their acute hospitalization period (48–96 hours), potentially contributing to the higher odds of pain during the 30-day postsurgical period. Early identification and management of high-risk pain trajectories can help in ascertaining appropriate pain management interventions. Such interventions can mitigate the occurrence of long-term disabilities associated with pain.

Prediction of Complications and Prognostication in Perioperative Medicine: A Systematic Review and PROBAST Assessment of Machine Learning Tools

“…Development of postoperative complications: Most studies focused on the prediction of postoperative acute complications 26–28,42,44–49,59,99,110,112,113,118,123 such as pain and opioid use, 53–57 postoperative atrial fibrillation (new-onset atrial fibrillation), 82 postoperative risk of stroke or myocardial infarction, 50,71,77 and delirium or cognitive decline. 65–70 Other models focused on the risk of developing pneumonia or respiratory failure, 83,85,125 acute kidney injury, 43,52,58,60–63,120–122 liver failure 117 or development of sepsis or surgical site infection.…”

Preoperative Versus Perioperative Risk Factors for Delayed Pain and Opioid Cessation After Total Joint Arthroplasty: A Prospective Cohort Study

“…Pain scores can be quickly assessed during postoperative phone calls, and timely interventions to influence opioid use trajectories could be implemented after such simple screening. Pain intensity over the first seven postoperative days is predictive of pain 1 year after total knee arthroplasty [ 42 ]. The correlation between the acute pain trajectory (i.e., over the first seven postoperative days) and acute OME use during the first postoperative week has also been reported [ 43 ], as well as the association of pain intensity on postoperative day 10 with time to opioid cessation [ 7 ].…”

Effect of different low doses of intrathecal morphine (0.1 and 0.2 mg) on pain and vital functions in patients undergoing total hip arthroplasty: a randomised controlled study

“…These bene ts notwithstanding, THA may be associated with signi cant postoperative pain, up to 5 (3)(4)(5)(6)(7) in the pain numeric rating scale (NRS) (2,3). Such pain may adversely affect patient recovery and early postoperative rehabilitation, and there is an increased risk of postoperative complications (4). Consequently, the hospital stay is longer, also incurring higher expenditures.…”