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Preoperative frailty and chronic pain after cardiac surgery: a prospective observational study
Britta C Arends1, Leon Timmerman2, Lisette M Vernooij1,3
1Department of Anesthesiology, Intensive Care, and Pain Medicine, St. Antonius Hospital, Koekoekslaan 1, 3430 EM, Nieuwegein, The Netherlands.
Insights
Older adults experiencing chronic pain after cardiac surgery often have worse physical quality of life. Preoperative frailty, medication use, and living situation are linked to this pain, suggesting targets for intervention.
Area of Science:
- Geriatric Medicine
- Cardiovascular Surgery
- Pain Management
Background:
- Chronic pain is common after cardiac surgery, negatively impacting health-related quality of life (HRQL).
- Frailty is a known risk factor for adverse surgical outcomes, but its association with chronic pain post-cardiac surgery is not well understood.
Purpose of the Study:
- To investigate the relationship between frailty and the development of chronic pain following cardiac surgery in elderly patients.
- To identify specific frailty domains associated with chronic postoperative pain.
Main Methods:
- A sub-study of the Anesthesia Geriatric Evaluation study included 518 patients aged 70 years or older undergoing elective cardiac surgery.
- Pain was assessed using the Short-Form 36 questionnaire preoperatively and one year post-surgery.
- Multivariable regression analysis examined associations between chronic pain and frailty domains (medication use, nutrition, mobility, function, cognition, HRQL, living situation, education).
Main Results:
- Chronic pain one year after surgery was reported by 182 patients (35%).
- Associated frailty domains included medication use, living situation, mobility, gait speed, physical functioning (Nagi), and preoperative HRQL.
- Patients with chronic pain had significantly worse physical HRQL one year post-surgery compared to those without pain (β -10.37).
Conclusions:
- Preoperative polypharmacy, living alone, physical frailty, and lower mental HRQL are associated with chronic pain after cardiac surgery.
- Chronic postoperative pain correlates with diminished physical HRQL one year following the procedure.
- Findings suggest potential preoperative interventions to mitigate chronic pain and improve HRQL in older surgical patients.
Background:
Chronic pain after cardiac surgery, whether or not related to the operation, is common and has negative impact on health related quality of life (HRQL). Frailty is a risk factor for adverse surgical outcomes, but its relationship with chronic pain after cardiac surgery is unknown. This study aimed to address the association between frailty and chronic pain following cardiac surgery.
Methods:
This sub-study of the Anesthesia Geriatric Evaluation study included 518 patients ≥ 70 years undergoing elective cardiac surgery. Pain was evaluated with the Short-Form 36 questionnaire prior to and one year after surgery. Associations between chronic postoperative pain and frailty domains, including medication use, nutritional status, mobility, physical functioning, cognition, HRQL, living situation and educational level, were investigated with multivariable regression analysis.
Results:
Chronic pain one year after cardiac surgery was reported in 182 patients (35%). Medication use, living situation, mobility, gait speed, Nagi's physical functioning and preoperative HRQL were frailty domains associated with chronic pain after surgery. For patients with chronic pain physical HRQL after one year was worse compared to patients without chronic pain (β -10.37, 99% CI -12.57 - -8.17).
Conclusions:
Preoperative polypharmacy, living alone, physical frailty and lower mental HRQL are associated with chronic pain following cardiac surgery. Chronic postoperative pain is related to worse physical HRQL one year after cardiac surgery. These findings may guide future preoperative interventions to reduce chronic pain and poor HRQL after cardiac surgery in older patients.
Trial Registration:
This trial has been registered before initiation under number NCT02535728 at clinicaltrials.gov.
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