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Prevalence and Risk Factors for Chronic Postsurgical Pain after Cardiac Surgery: A Single-center Prospective Cohort
Maggie Z X Xiao1, James S Khan1, Elad Dana2
1Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada.
Insights
Chronic postsurgical pain affects nearly one-third of cardiac surgery patients at 3 months, with depression and female sex being key risk factors. Persistent pain impacts 15% at one year, highlighting the need for targeted interventions.
Area of Science:
- Cardiology
- Pain Medicine
- Psychosomatic Medicine
Background:
- Chronic postsurgical pain is a frequent complication following surgery.
- Psychological factors, such as depression and anxiety, are understudied in cardiac surgery pain.
- Identifying perioperative risk factors is crucial for managing postsurgical pain.
Purpose of the Study:
- To identify perioperative factors associated with chronic pain up to 12 months post-cardiac surgery.
- To investigate the influence of baseline psychological vulnerabilities on chronic postsurgical pain.
- To determine the incidence and characteristics of neuropathic pain phenotypes after cardiac surgery.
Main Methods:
- Prospective cohort study of 1,059 patients undergoing cardiac surgery.
- Collection of demographic, psychological, and perioperative data.
- Follow-up questionnaires at 3, 6, and 12 months to assess chronic pain.
Main Results:
- 29% of patients reported pain at 3 months, decreasing to 15% at 12 months.
- Neuropathic pain phenotypes increased over time, from 34% at 3 months to 64% at 12 months.
- Factors associated with pain included female sex, pre-existing pain, prior surgery, depression, pain catastrophizing, and acute postoperative pain.
Conclusions:
- Nearly one-third of patients experience postsurgical pain at 3 months, with 15% experiencing persistent pain at 1 year.
- Female sex, pre-existing chronic pain, and baseline depression are significant predictors of postsurgical pain.
- Psychological factors play a substantial role in the development and persistence of chronic pain after cardiac surgery.
Background:
Chronic postsurgical pain is a common complication of surgery. The role of psychologic risk factors like depression and anxiety is substantially understudied in cardiac surgery. This study sought to identify perioperative factors associated with chronic pain at 3, 6, and 12 months after cardiac surgery. The authors hypothesize that baseline psychologic vulnerabilities have a negative influence on chronic postsurgical pain.
Methods:
The authors prospectively collected demographic, psychologic, and perioperative factors in a cohort of 1,059 patients undergoing cardiac surgery at the Toronto General Hospital between 2012 and 2020. Patients were followed and completed chronic pain questionnaires at 3, 6, and 12 months after surgery.
Results:
The study included 767 patients who completed at least one follow-up questionnaire. The incidence of postsurgical pain (more than 0 out of 10) at 3, 6, and 12 months after surgery was 191 of 663 (29%), 118 of 625 (19%), and 89 of 605 (15%), respectively. Notably, among patients reporting any pain, the incidence of pain compatible with a neuropathic phenotype increased from 56 of 166 (34%) at 3 months to 38 of 97 (39%) at 6 months and 43 of 67 (64%) at 12 months. Factors associated with postsurgical pain scores at 3 months include female sex, pre-existing chronic pain, previous cardiac surgery, preoperative depression, baseline pain catastrophizing scores, and moderate-to-severe acute pain (4 or more out of 10) within 5 postoperative days.
Conclusions:
Nearly one in three patients undergoing cardiac surgery reported pain at 3 months of follow-up, with approximately 15% reporting persistent pain at 1 yr. Female sex, pre-existing chronic pain, and baseline depression were associated with postsurgical pain scores across all three time periods.
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