Predictors of post-discharge pain outcomes after colorectal surgery: a prospective cohort study

Post-discharge pain management after colorectal surgery is challenging due to the multifactorial nature of pain and the risks of adverse events. Identifying modifiable factors associated with pain outcomes may help optimize care. This study aimed to assess the extent to which patient and care-related factors impact 7-day post-discharge pain outcomes after colorectal surgery.

This cohort study included adult patients undergoing elective colorectal surgery at two university-affiliated hospitals in Canada. Preoperative assessments included demographics, Pain Catastrophizing Scale, and PROMIS-29 anxiety and depression scales. 7-day post-discharge pain outcomes included PROMIS-29 pain intensity (range 0-10), pain interference (41.6-75.6), and satisfaction with pain management (high [10-9] vs. lower [8-0]). The association of potential predictors with pain outcomes was evaluated using Bayesian Model Averaging, with higher posterior effect probability (PEP) reflecting stronger evidence of association.

347 patients were included (59 ± 15 years, 53% male, 64% laparoscopic, 31% rectal resection, length of stay 3 days [IQR 2-5], same-day discharge 18%). At 7 days post-discharge, the median patient-reported pain intensity was 3/10 [1-4], pain interference was 58 [IQR 54-65], and 38% of patients reported lower satisfaction with pain management. Chronic pain was associated with greater pain intensity (β = 0.68; PEP = 78%) and lower satisfaction with pain management (OR = 1.72; PEP = 75%). Increased pain interference was associated with younger age (β = - 0.10; PEP = 98%), same-day discharge (β = 3.61; PEP = 86%), anxiety (β = 0.14; PEP = 71%), pain catastrophizing (β = 0.08; PEP = 66%), and female sex (β = 1.24; PEP = 54%). Depression predicted lower satisfaction (OR = 1.04; PEP = 81%), while TAP block use was associated with greater satisfaction (OR = 0.71; PEP = 52%).

In this study, post-discharge pain outcomes after colorectal surgery were generally positive, and influenced by an interplay of demographic, clinical, emotional, and care-related factors. These findings provide valuable insights to inform multifaceted strategies to improve pain outcomes and enhance patient experiences.