How Much Pain Will I Have After Surgery? A Preoperative Nomogram to Predict Acute Pain Following Mastectomy

Abstract

Introduction. Acute postoperative pain affects time to opioid cessation and quality of life, and is associated with chronic pain. Effective screening tools are needed to identify patients at increased risk of experiencing more severe acute postoperative pain, and who may benefit from multimodal analgesia and early pain management referral. In this study, we develop a nomogram to preoperatively identify patients at high risk of moderate-severe pain following mastectomy. Methods. Demographic, psychosocial, and clinical variables were retrospectively assessed in 1195 consecutive patients who underwent mastectomy from January 2019 to December 2020 and had pain scores available from a postdischarge questionnaire. We examined pain severity on postoperative days 1-5, with moderate-severe pain as the outcome of interest. Multivariable logistic regression was performed to identify variables associated with moderatesevere pain in a training cohort of 956 patients. The final model was determined using the Akaike information criterion. A nomogram was constructed using this model, which also included a priori selected clinically relevant variables. Internal validation was performed in the remaining cohort of 239 patients.

Risk Factors for Acute Postsurgical Pain: A Narrative Review

“…Two prospective cohort studies and two retrospective cohort studies have revealed that age, being a continuous variable, is not an independent risk factor for moderate-to-severe APSP after the confounding factors are controlled. [38][39][40][41] Strutz et al 42 reported that the continuous variable age was not significantly related to APSP intensity after the perioperative opioid dose was controlled. Significant heterogeneity may be observed because of the variable age and other strong confounding factors.…”

“…30,45,49 Moreover, BMI was reported to be a significant risk factor for moderate-to-severe acute pain after open radical gastrectomy, 56 thoracoscopic surgery, 29 and breast cancer surgery. 38 One retrospective study and one cross-section study have noted the correlation between BMI and APSP. These studies reported that BMI is not significantly correlated with APSP intensity following total hip arthroplasty and anterior cervical discectomy and fusion.…”

Acute and subacute postsurgical pain in women with breast cancer: incidence and associations with biopsychosocial predictors—a secondary analysis of a randomized controlled trial

“…26 Mismanaged pain during the acute and subacute periods is not only uncomfortable but also associated with an increased risk of CPSP. 1,35 In a recent study on APSP after mastectomy, 31 most women experienced APSP, and 68.9% of the sample reported pain of moderate or greater intensity. Some surgical patients are discharged despite ongoing pain, at times with insufficient analgesic medication.…”

Patient and procedure characteristics associated with postoperative pain after prophylactic versus therapeutic ambulatory bilateral breast surgery

“…7,8,10,11 However, it appears axillary lymph node dissection may not be associated with acute pain after mastectomy. 12 Among other factors, risk-reducing bilateral mastectomy with reconstruction has been reported to be associated with more pain 1 week after surgery. 5 Younger women's decision to undergo prophylactic bilateral mastectomy is often driven by fear and anxiety.…”

“…Other risk factors for chronic pain after breast cancer surgery include axillary lymph node dissection 7,8,10,11 . However, it appears axillary lymph node dissection may not be associated with acute pain after mastectomy 12 …”