QUIPS-based prospective postoperative pain assessment following nephrectomy and partial nephrectomy in...

Postoperative pain is one of the most common medical issues following kidney surgery. It has significant impact on morbidity, recovery and patient satisfaction. To date, limited data are available on the relationships between surgical procedures, postoperative pain progression, and quality-of-life parameters.

116 patients were recorded prospectively after minimally invasive (robot-assisted and conventional laparoscopic) and open surgical kidney procedures. Data collection was standardized as part of the Quality Improvement in Postoperative Pain Management (QUIPS) project. Primary endpoints were postoperative pain intensities (numerical rating scale, NRS) during movement, maximum and minimum pain. Secondary endpoints included need of analgesics, side effects, patient satisfaction, and length of hospital stay.

Both groups demonstrated high postoperative pain intensities. However, patients undergoing minimally invasive procedures presented with lower pain scores compared to those who underwent open surgery (pain on exercise: median 6 [IQR 4-8] vs. 7 [IQR 5-8], p = 0.050; maximum pain: median 7 [IQR 5-8] vs. 8 [IQR 6-9.8], p = 0.004; minimal pain: median 1 [IQR 0-2] vs. 2 [IQR 0-3]; p = 0.030). The need for opioids on the ward was higher after open procedures [25/62 (40.3%) vs. 11/54 (20.4%); p = 0.021]. Patient satisfaction scores were high across both groups [minimally invasive: median 8 [IQR 6-10]; open: median 8 [IQR 6-9]; p = 0.905]. Robot-assisted procedures were also associated with the lowest postoperative pain scores [pain on exercise: median 5 [IQR 4-7]; maximum pain: median 6 [IQR 5-8]; minimal pain: median 0 [IQR 0-2]] and the shortest hospital stay [median 7 days (IQR 6.8-9)].

Despite advances in pain management, postoperative pain following kidney surgery remains a significant medical issue. Our data suggest that pain management across different surgical modalities may not be homogeneous. Instead, different operative approaches may require procedure-adapted pain management with tailored analgesic escalation strategies to optimize postoperative recovery and patient satisfaction.