Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study

Lü, Yi; Hu, Bang; Dai, Haitao; Bao, Wang; Yao, Jiayin; Yao, Xinhua

doi:10.2147/ijgm.s337170

Cited by 12 publications

(11 citation statements)

References 39 publications

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“…Our study confirms that CPSP is common in elderly patients with a comparable incidence reported in previous studies. A multi-center retrospective study reported an incidence of 27.2% in patients aged > 65 years 6 months after hip arthroplasty [ 18 ]. A recent retrospective study, authors found that CPSP occurred in 30.8% of the elderly patients (aged ≥ 60 years), 3 months following orthopedic surgery [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

A prospective study of chronic postsurgical pain in elderly patients: incidence, characteristics and risk factors

et al. 2023

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Background Due to the continued growth of surgical procedures in older adults and the significant impact of chronic postsurgical pain (CPSP), it is crucial to improve our understanding of the occurrence of CPSP as well as the appropriate prevention and treatment. We therefore conducted this study to determine the incidence, characteristics and risk factors of CPSP in elderly patients at both 3 and 6 months after surgery. Methods Elderly patients (aged ≥ 60 years) undergoing elective surgery in our institution between April 2018 and March 2020 were prospectively enrolled in this study. Data on demographics, preoperative psychological well-being, intraoperative surgical and anesthesia management, and acute postoperative pain intensity were collected. At 3 and 6 months after surgery, patients received telephone interview and completed the questionnaires regarding chronic pain characteristics, analgesic consumption, and interference of the pain with activities of daily living (ADL). Results A total of 1065 elderly patients were followed up for 6 postoperative months and included in final analysis. At 3 and 6 months after operation, the incidence of CPSP was 35.6% [95% confidence interval (95% CI) 32.7 − 38.8%] and 21.5% (95% CI 19.0% − 23.9%), respectively. CPSP cause negative impacts on patient’s ADL and most particularly on mood. Neuropathic features were found in 45.1% of the patients with CPSP at 3 months. At 6 months, 31.0% of those with CPSP reported that the pain had neuropathic features. Preoperative anxiety [3 months: Odds ratio (OR) 2.244, 95% CI 1.693 to 2.973; 6 months: OR 2.397, 95% CI 1.745 to 3.294], preoperative depression (3 months: OR 1.709, 95% CI 1.292 to 2.261; 6 months: OR 1.565, 95% CI 1.136–2.156), orthopedic surgery (3 months: OR 1.927, 95% CI 1.112 to 3.341; 6 months: OR 2.484, 95% CI 1.220 to 5.061), higher pain severity on movement within postoperative 24 h (3 months: OR 1.317, 95% CI 1.191 to 1.457; 6 months: OR 1.317, 95% CI 1.177 to 1.475) were associated with a higher risk for CPSP independently at both 3 and 6 months after surgery. Conclusions CPSP is a common postoperative complication in elderly surgical patients. Preoperative anxiety and depression, orthopedic surgery, and greater intensity of acute postoperative pain on movement are associated with an increased risk for CPSP. It should be kept in mind that developing psychological interventions to reduce anxiety and depression and optimizing the management of acute postoperative pain will be effective in reducing the development of CPSP in this population.

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Section: Discussionmentioning

confidence: 99%

A prospective study of chronic postsurgical pain in elderly patients: incidence, characteristics and risk factors

et al. 2023

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“…A former study analyzed the relationship between bleeding volume and CPSP undergoing hip arthroplasty in elderly patients aged >65 years, but the result was no statistical correlation (OR 1.001,95% CI1.000 to 1.002, p=0.094). 16 Thus the relationship between pain and intraoperative bleeding needs to be further studied and explored.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 CPSP is a common problem but often difficult to treat. In order to find individuals who were more prone to develop CPSP, studies 9,16,17,28,29 had identified some perioperative risk factors and developed some prediction models for CPSP in adults (≥18 years); however, the data remained unclear for elderly patients over 65 years old. Based on previous reports, we selected eighteen variables as candidates and the final model included 6 variables.…”

Section: Discussionmentioning

confidence: 99%

“…Variables that might have an association with CPSP were selected based on literature review and our previous study. 9,[13][14][15][16][17][18] Information collected via medical records included sex, age, BMI, history of smoking and drinking, presence of hypertension and diabetes mellitus, history of operation, approach of surgery, duration of surgery, type of anesthesia, blood loss, duration of chest tube drainage, additional needs for analgesic after surgery, length of hospital stay, pre-operative white blood cell count, preoperative neutrophil count, preoperative monocyte count. The operational methods included videoassisted thoracic surgery (VATS) and thoracotomy.…”

Section: Demographic Data Collectionmentioning

confidence: 99%

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Development and Validation of a Prediction Model for Chronic Post-Surgical Pain After Thoracic Surgery in Elderly Patients: A Retrospective Cohort Study

Wu¹,

Zeng²,

Yu³

et al. 2022

JPR

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Purpose Chronic post-surgical pain (CPSP) is one of the adverse outcomes after surgery, especially in thoracotomy. However, the prevalence of CPSP in elderly adults (≥65 years), is still limited. Therefore, the present study was undertaken to establish and validate the prediction model of CPSP in those patients after thoracic surgery, including thoracotomy and video-assisted thoracoscopic surgery. Patients and Methods This retrospective, observational single-center cohort study was conducted in Nanfang Hospital, Southern Medical University, which randomly and consecutively collected 577 elderly patients who underwent thoracic surgery between January 1, 2017, and December 31, 2020. According to the Akaike information criterion, the prediction model was built based on all the data and was validated by calibration with 500 bootstrap samples. Results The mean age of participants was 69.09±3.80 years old, and 63.1% were male. The prevalence of CPSP was 26.9%. Age more than 75 years, BMI, blood loss, longer length of hospital stays, and higher pre-operative neutrophil count were associated with CPSP. Except for these factors, we incorporated history of drinking to build up the prediction model. The areas under the curve (AUCs) of the prediction models were 0.66 (95% CI, 0.61–0.71) and 0.64 (95% CI, 0.59–0.69) in the observational and validation cohorts, respectively. And the calibration curve of the predictive model showed a good fit between the predicted risk of CPSP and observed outcomes in elderly patients. Conclusion The present developed model may help clinicians to find high-risk elderly patients with CPSP after thoracic surgery and take corresponding measures in advance to reduce the incidence of CPSP and improve their life quality.

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“…At present, clinicians mostly use multimode analgesia, combining nerve blocks and a variety of analgesic drugs to reduce pain. However, the prevalence of CPSP remains high (De Luca et al, 2018;Lu et al, 2021;Wylde et al, 2018). With the continued exploration of mechanisms of pain, the roles of genetic factors in pain have garnered more attention.…”

Section: Conclusion and Limitationsmentioning

confidence: 99%

Association between single nucleotide variants and severe chronic pain in older adult patients after lower extremity arthroplasty

Jin

Tang

et al. 2023

Preprint

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Background Hip or knee osteoarthritis (OA) is one of the main causes of disability worldwide and occurs mostly in the older adults. Total hip or knee arthroplasty is the most effective method to treat OA. However, severe postsurgical pain leading to a poor prognosis. So, investigating the population genetics and genes related to severe chronic pain in older adult patients after lower extremity arthroplasty is helpful to improve the quality of treatment. Methods We collected blood samples from elderly patients who underwent lower extremity arthroplasty from September 2020 to February 2021 at the Drum Tower Hospital Affiliated to Nanjing University Medical School. The enrolled patients provided measures of pain intensity using the numerical rating scale on the 90th day after surgery. Patients were divided into the case group (Group A) and the control group (Group B) including 10 patients respectively by the numerical rating scale. DNA was isolated from the blood samples of the two groups for whole-exome sequencing. Results In total, 661 variants were identified in the 507 gene regions that were significantly different between both groups (P < 0.05), including CASP5, RASGEF1A, CYP4B1, etc. These genes are mainly involved in biological processes, including cell–cell adhesion, ECM–receptor interaction, metabolism, secretion of bioactive substances, ion binding and transport, regulation of DNA methylation, and chromatin assembly. Conclusions The current study shows some variants within genes are significantly associated with severe postsurgical chronic pain in older adult patients after lower extremity arthroplasty, indicating a genetic predisposition for chronic postsurgical pain. The study was registered according to ICMJE guidelines. The trial registration number is ChiCTR2000031655 and registration date is April 6th, 2020.

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Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study

Cited by 12 publications

References 39 publications

A prospective study of chronic postsurgical pain in elderly patients: incidence, characteristics and risk factors

A prospective study of chronic postsurgical pain in elderly patients: incidence, characteristics and risk factors

Development and Validation of a Prediction Model for Chronic Post-Surgical Pain After Thoracic Surgery in Elderly Patients: A Retrospective Cohort Study

Association between single nucleotide variants and severe chronic pain in older adult patients after lower extremity arthroplasty

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