Incidence and Risk Factors for Chronic Postsurgical Pain Following Video-assisted Thoracoscopic Surgery: a Retrospective Study

Abstract

Backgroud: Video-assisted thoracoscopic surgery (VATS) has been widely used as an alternative for thoracotomy, but the reported incidence of chronic postsurgical pain (CPSP) following VATS varied widely. The purpose of this study was to investigate the incidence and risk factors for CPSP after VATS. Methods: We retrospectively collected preoperative demographic, anesthesiology, and surgical factors in a cohort of patients undergoing VATS between January 2018 and October 2020. Patients were interviewed via phone survey for pain intensity, and related medical treatment 3 months after VATS. Univariate and multivariate analysis were used to explore independent risk factors associated with CPSP.Results: 2,348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1,033 of 2,348). Within those suffering CPSP, 14.71% (n = 152 of 1,033) patients reported moderate or severe chronic pain. Only 15.23% (n = 23 of 152) patients with moderate to severe chronic pain sought active analgesic therapies. According to multivariable analysis, age ＜ 65 years (OR 1.278, 95% CI 1.057-1.546, P = 0.011), female (OR 1.597, 95% CI 1.344-1.898, P < 0.001), education level less than junior school (OR 1.295, 95% CI 1.090-1.538, P = 0.003), preoperative pain (OR 2.564, 95% CI 1.696-3.877, P < 0.001), consumption of rescue analgesia postoperative (OR 1.248, 95% CI 1.047-1.486, P = 0.013), consumption of sedative hypnotic postoperative (OR 2.035, 95% CI 1.159-3.574, P = 0.013), subcutaneous emphysema of chest wall postoperative (OR 1.255, 95% CI 1.000-1.575, P = 0.050), and history of postoperative wound infection (OR 5.949, 95% CI 1.344-1.898, P < 0.001) were independent risk factors for CPSP development.Conclusions: CPSP remains a challenge in clinic because half of patients may develop CPSP after VATS. Trial registration: Chinese Clinical Trial Registry (ChiCTR2100045765), 2021/04/24

Postoperative Pain in Patients Undergoing Cancer Surgery and Intravenous Patient-Controlled Analgesia Use: The First and Second 24 h Experiences

“…Younger patients are biologically more sensitive to low-intensity noxious stimuli and may have higher central nervous system reactivity. Second, from a physiological perspective, older adults are more conservative in pain perception and reporting and are more reluctant to report pain when it occurs [26]. In our study, the effect of age as a determinant factor in patients' pain risk when referring to the pain-free group was observed for both days after multiple adjustment, but the direction of influence seemed not decisive.…”

Does Preoperative Hookwire Localization Influence Postoperative Acute and Chronic Pain After Video-Assisted Thoracoscopic Surgery: A Prospective Cohort Study

“…A large retrospective study on thoracic surgery reported that around 1/3 of patients suffering from CPSP reported moderate or severe chronic pain, but only 3% of patients with CPSP sought active analgesic therapy. 1 In the present study, the incidence of CPSP in patients with and without hookwire localization was 56.5% and 30.4%, respectively, and the incidence was higher (62.9%) in patients undergoing multiple hookwires localization. Nevertheless, most of the patients in our study reported mild-to-moderate pain intensities.…”

“…The incidence of CPSP in thoracic surgery varies from 14% to 83% depending on the type of surgery or the definition of CPSP. [1][2][3][4] CPSP can lead to increased postoperative complications, long-term disability, reduced quality of life, and increased healthcare spending. 5 The development of CPSP is considered a multifactorial process.…”

“…18 CPSP after thoracic surgery is relatively common, and the incidence rate is as high as 65%. 19 A meta-analysis of prospective studies reported that the incidence of CPSP at 3 and 6 months after thoracotomy was 57% and 47%, respectively, 20 whereas the incidence of CPSP after VATS varied greatly from 7.7% to 44.0%, 1,18,[21][22][23] depending on the perioperative pain control and the number of ports. Notably, the definition of CPSP also influences the incidence.…”

Transbronchial Lung Cryobiopsy for Diffuse Parenchymal Lung Disease

“…It has been reported to occur in 15% (365/2,396) in one case series and 44% (1,033/2,348) in another with 6.5% (152/2,348) in the moderate to severe range. 55,56…”