Chronic Pain, Quality of Life and Functional Impairment After Emergency Laparotomy

Emergency laparotomy is a high-risk procedure with increased morbidity and mortality rates. The long-term outcomes are poorly investigated.The aim was to describe the frequency of chronic postsurgical pain (CPSP), pain-related functional impairment, to evaluate the gastrointestinal quality of life (QoL) and identify risk factors for CPSP after emergency laparotomy.

A questionnaire study was conducted from Copenhagen University Hospital Herlev. Population area: 435.000. Patients undergoing emergency midline laparotomy from May 2009-May 2013 and June 2014-November 2015 were included. The survey consisted of five parts exploring the extent of acute and chronic postsurgical pain. Pain-related functional impairment and quality of life were measured using the activity assessment scale and the gastrointestinal quality of life questionnaire, respectively. Primary outcomes were rates of CPSP and pain-related functional impairment. Gastrointestinal QoL was compared between patients with or without CPSP. Multivariate regression analysis was performed to estimate risk factors for CPSP.

The primary emergency laparotomy population consisted of 1573 patients. A total of 605 patients were eligible for inclusion, and 440 patients completed the survey. Response rate: 73%. Median age was 69 years (range 18-95), 56.4% female. Median follow-up was 60 months (IQR 47). 19% (85/440) experienced CPSP and had low gastrointestinal QoL. We identified APSP OR 5.0 95%CI (2.4-10.5), p < 0.01 and age < 60 OR 2.1 95%CI (1.2-3.8), p = 0.01 as independent risk factors for CPSP. 45% (199/440) of all patients experienced moderate-severe functional impairment.

CPSP (19%) and low gastrointestinal QoL were common after emergency laparotomy and almost every second patient had moderate-severe functional impairment on long-term follow-up.