Preoperative quality‐of‐life measures predict acute postoperative pain in endoscopic sinus surgery

Abstract

Objectives Recent increases in opioid‐related mortality have prompted a critical evaluation of postoperative pain management across all specialties. However, successfully limiting narcotic overprescription requires perioperative identification of patients who are at risk for high postoperative pain. Unfortunately, quality data to guide practice patterns are lacking. We therefore prospectively investigated several possible predictive factors of postoperative pain after endoscopic sinus surgery (ESS). Methods Sixty‐four consecutive patients undergoing ESS were enrolled. Baseline 22‐item SinoNasal Outcomes Test (SNOT‐22) and Short‐Form 8 (SF‐8) scores were obtained. Pain scores were collected postoperatively using a numeric rating scale. Spearman correlations and univariate linear regression models were used to investigate relationships between postoperative pain, patient factors, and SNOT‐22/SF‐8 domain scores. Multivariate linear regression was then performed to control for potential confounding variables. Results Day‐of‐surgery pain scores were significantly correlated with the SF‐8 role‐physical domain (Rs = 0.32, P = 0.04). Whereas SF‐8 pain scores were initially nonsignificant, at postoperative day 3 (POD3) the preoperative SF‐8 pain score became correlated with self‐reported pain (Rs = 0.39, P = 0.02). SNOT‐22 total and subdomain scores were not associated with pain scores at any time point. Multivariate linear regression modelling identified baseline SF‐8 role‐physical and pain scores, smoking status, and undergoing a modified Lothrop procedure as significant independent predictors of POD3 pain (adjusted R2 = 0.359, P < 0.0001). Conclusion Baseline patient‐reported global quality‐of‐life measures are associated with postoperative pain after ESS. Large multicenter studies are necessary to validate these findings and investigate additional factors associated with postoperative pain following ESS. Level of Evidence 2c Laryngoscope, 129:1274–1279, 2019

Association of gastro-oesophageal reflux disease and quality of life in patients with chronic rhinosinusitis

“…In our results, the proportion of nasal polyposis patients was not significantly different between GERD vs non-GERD group, in consistence with literature before 18 . Chowdhury et al reported pre-operative QOL as a prognostic factor for post-operative outcomes in CRS patients 19 . Pre-operative SNOT-22 was associated with post-operative improvement of CRS-related QOL in our study.…”

American Rhinologic Society expert practice statement: Postoperative pain management and opioid use after sinonasal surgery

“…One study encompassing 64 patients undergoing ESS identified a modified Lothrop as an independent significant predictor of postoperative day 3 pain. 53 However, in another retrospective review of 121 patients, septoplasty, revision, Draf IIB, and Draf III procedures were not associated with additional opioid prescriptions. 55 Consequently, it remains unclear whether extent of surgery has any impact on postoperative pain or opioid use.…”

“…Studies demonstrating associations between increased analgesic needs and preoperative health status, comorbid depression, and worse baseline quality-of-life assessment scores will need to be substantiated in larger populations while simultaneously developing strategies to effectively manage patients identified as being at risk. 19,21,53,54 Development of predictive metrics to identify an individual's preoperative predisposition to experience persistence of acute postoperative pain as chronic postsurgical pain are needed to better characterize this unique population with an increased likelihood to develop opioid dependence. 52 Similarly, there is limited literature that offers guidance on how to manage patients with previous substance abuse, where indicators for consistent involvement of a chronic pain team may be warranted.…”

Preoperative Gabapentin Administration and Its Impact on Postoperative Opioid Requirement and Pain in Sinonasal Surgery

“…Neither extent of surgery nor disease severity influenced VAS or MED in either cohort, 25 and there was no effect of SNOT-22 on these outcomes. 26 Both these results require confirmation with larger sample sizes and uniform surgical technique. The average patient in the control group required 1.6 tablets of oxycodone on POD 1 to 2 and <1 tablet for the remainder of the postoperative course.…”