Risk of Pain and Gastrointestinal Complaints at 6Months After Elective Abdominal Surgery

The incidence of chronic postoperative abdominal pain (CPAP) after abdominal surgery is substantial and decreases overall quality of life. One in 3 patients report pain-related interference with mood, sleep, and enjoyment of life and 12% visit the emergency department for pain-related symptoms. Previous studies lack data on preoperative health and pain status or are limited by small patient samples. The aim of this study was to assess risk factors for CPAP and gastrointestinal complaints 6 months after surgery. A prospective cohort study was performed including patients undergoing an elective laparotomy or laparoscopy at a tertiary referral center. Relevant patient, pain, surgical, and medical data as well as the Gastrointestinal Symptom Rating Scale (GSRS) were assessed before, during, and after hospital stay and at the outpatient clinic until 6 months after discharge. Linear and logistic regression analysis were used to assess risk factors. Of 518 included patients, 184 (36%) had CPAP. The median GSRS score was 5 (interquartile range = 3-10). The presence of preoperative pain for <3 months (odds ratio [OR] = 2.69, P = .016) or >3 months (OR = 3.99, P = .000), use of opioid analgesia preoperatively (OR = 3.54, P = .001), severe adhesions underneath the incision (OR = 1.63, P = .040), and the numeric rating scale pain score on postoperative day 2 (OR = 1.23, P = .004) independently increased the risk for chronic abdominal pain. Chronic pancreatitis as indication for surgery (B = 4.20, P = .03), ≥3 previous abdominal operations (B = 1.03, P = .03), presence of pain >3 months before surgery (B = 1.61, P < .01), upper gastrointestinal tract as the anatomic location of surgery (B = 1.43, P = .03), and a higher preoperative GSRS score (B = .36, P < .01) independently increased the GSRS score 6 months after surgery. The duration and severity of preoperative pain and more severe acute postoperative pain were the most relevant risk factors for CPAP. The number of operations and the anatomic location of the operation showed to be important risk factors for increasing the number of gastrointestinal complaints. Perspective: This prospective observational study shows the incidence and risk factors for CPAP after major abdominal surgery. Preoperative pain-related factors were associated with the occurrence of CPAP.