Relationship Between Postoperative Pain and Overall 30-Day Complications in a Broad Surgical Population

Boekel, R.L.M. van; Warlé, Michiel C.; Nielen, Renske G C; Vissers, Kris; Sande, Rob van der; Bronkhorst, Ewald M.; Lerou, J.G.C.; Steegers, Monique A H

doi:10.1097/sla.0000000000002583

Cited by 125 publications

(107 citation statements)

References 56 publications

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“…A previous study reported that poorly controlled postoperative pain is associated with increased morbidity, development of persistent pain, and prolonged opioid use. 27 Considering that severe postoperative pain is closely related to overall 30-day complications after surgery, 28 severe postoperative pain associated with inadequate analgesia could have affected the increase in 30-day unplanned readmission rate in this study as a confounder. However, in the matched cohorts, there was no significant difference between the proportion of pain as a chief complaint in 30-day unplanned readmissions in the neostigmine group (3.6%, 40/1124) and that in the sugammadex group (3.4%, 12/355) (P¼0.271).…”

Section: Chief Complaint For 30-day Unplanned Readmissionmentioning

confidence: 86%

Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine

Ryu

et al. 2019

British Journal of Anaesthesia

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Background: Sugammadex is associated with fewer postoperative complications, but its impact on 30-day unplanned readmission is unclear. Methods: This was a single-centre retrospective observational study of patients after major abdominal surgery between 2010 and 2017, where rocuronium was the only neuromuscular blocker used. The primary endpoint was the difference in incidence of 30-day unplanned readmission between reversal with sugammadex or neostigmine. The secondary endpoints were the length of hospital stay after surgery and related hospital charges (total charges excluding those related to surgery and anaesthesia). Analysis included propensity score matching and generalised mixed-effects modelling. Results: Mixed-effects logistic regression analysis of 1479 patients (sugammadex: 355; neostigmine: 1124) showed that the incidence of 30-day unplanned readmission was 34% lower (odds ratio [OR]: 0.66, 95% confidence interval [CI]: 0.46e0.96, P¼0.031), the length of hospital stay was 20% shorter (exponential regression coefficient: 0.80, 95% CI: 0.77e0.83, P<0.001), and related hospital charges were 24% lower (exponential regression coefficient: 0.76, 95% CI: 0.67e0.87, P<0.001) in the sugammadex group than in the neostigmine group. For patients living !50 km from the hospital, the incidence of 30-day unplanned readmission was 68% lower in the sugammadex group than in the neostigmine group (OR: 0.32, 95% CI: 0.13e0.79, P¼0.014), while it was not significant for patients living <50 km from the hospital (P¼0.319). Conclusions: Compared with neostigmine, reversal of rocuronium with sugammadex after major abdominal surgery was associated with a lower incidence of 30-day unplanned readmission, a shorter hospital stay, and lower related hospital charges.

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Section: Chief Complaint For 30-day Unplanned Readmissionmentioning

confidence: 86%

Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine

Ryu

et al. 2019

British Journal of Anaesthesia

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“…Secondly, our follow-up is limited to 48 hours and we did not evaluate postoperative complications. Nevertheless, our focus is to deeply understand the psychological vulnerability influence on postoperative pain, considering that adequate pain management is intrinsically linked to rehabilitation [32] and the reduction of complications [33]. Lastly, in a clinical study, it is not possible to directly assess and isolate the effect of each potential confounding factor of the dependent variables, especially because the number of predictors is high for such complex pain-related outcomes.…”

Section: Discussionmentioning

confidence: 99%

The Brief Measure of Emotional Preoperative Stress (B-MEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study

et al. 2020

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Background Preoperative patients' vulnerabilities such as physical, social, and psychological are implicated in postoperative pain variability. Nevertheless, it is a challenge to analyze a patient's psychological profile in the preoperative period in a practical and consistent way. Thus, we sought to identify if high preoperative emotional stress, evaluated by the Brief Measure of Emotional Preoperative Stress (B-MEPS) scale is associated with higher postoperative pain levels and poor rehabilitation in patients submitted to intermediate or major surgery. Moreover, the possible neurobiological or neurophysiological mechanisms implicated in high preoperative emotional stress, evaluated through preoperative quantitative sensory pain tests and serum biomarkers BDNF and S100B were investigated. Methods We conducted a prospective, observational, cohort study of ASA 2 and 3 adult patients undergoing major urologic, gynecologic, proctologic and orthopedic surgeries from March 2017 to March 2018. B-MEPS and Central Sensitivity Inventory were evaluated preoperatively, followed by a sequence of experimental pain tests and serum biomarkers collection. Postoperative evaluation carried out within the first 48 hours after surgery comprehended pain at rest and movement-evoked pain, and the consumption of morphine. Quality-of-Recovery was also evaluated in the 3rd postoperative day. Results 23 (15%) out of 150 patients included in the study presented high emotional preoperative stress. Variables significantly related to preoperative stress were: previous psychiatric

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“… 3 , 7 This is surprising because evidence-based guidelines for the treatment of acute postoperative pain are generated continuously. 1 , 5 , 21 In addition, severe (and long-lasting) acute pain early after surgery is one major predictor for postoperative complications 26 and chronic postoperative pain. 6 One reason for the gap between available knowledge and insufficient therapy might be the different responses to pain and analgesics between individual patients.…”

Section: Introductionmentioning

confidence: 99%

Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients

Schnabel

Yahiaoui-Doktor

Meißner

et al. 2020

PR9

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Relationship Between Postoperative Pain and Overall 30-Day Complications in a Broad Surgical Population

Abstract: Higher actual postoperative pain scores and unacceptable pain, even on the first postoperative day, are associated with more postoperative complications. Our findings provide important support for the centrality of personalized analgesia in modern perioperative care.

Cited by 125 publications

References 56 publications

Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine

Retrospective analysis of 30-day unplanned readmission after major abdominal surgery with reversal by sugammadex or neostigmine

The Brief Measure of Emotional Preoperative Stress (B-MEPS) as a new predictive tool for postoperative pain: A prospective observational cohort study

Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients

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