Highlights
- •One in 3 patients will have chronic postoperative abdominal pain 6 months after elective abdominal surgery.
- •Pain-related factors and adhesions at the incision were associated with chronic postoperative abdominal pain.
- •A higher preoperative mental health score were associated with a lower risk of chronic postoperative abdominal pain.
Abstract
The incidence of chronic postoperative abdominal pain (CPAP) after abdominal surgery
is substantial and decreases overall quality of life. One in 3 patients report pain-related
interference with mood, sleep, and enjoyment of life and 12% visit the emergency department
for pain-related symptoms. Previous studies lack data on preoperative health and pain
status or are limited by small patient samples. The aim of this study was to assess
risk factors for CPAP and gastrointestinal complaints 6 months after surgery. A prospective
cohort study was performed including patients undergoing an elective laparotomy or
laparoscopy at a tertiary referral center. Relevant patient, pain, surgical, and medical
data as well as the Gastrointestinal Symptom Rating Scale (GSRS) were assessed before,
during, and after hospital stay and at the outpatient clinic until 6 months after
discharge. Linear and logistic regression analysis were used to assess risk factors.
Of 518 included patients, 184 (36%) had CPAP. The median GSRS score was 5 (interquartile
range = 3–10). The presence of preoperative pain for <3 months (odds ratio [OR] = 2.69,
P = .016) or >3 months (OR = 3.99, P = .000), use of opioid analgesia preoperatively (OR = 3.54, P = .001), severe adhesions underneath the incision (OR = 1.63, P = .040), and the numeric rating scale pain score on postoperative day 2 (OR = 1.23,
P = .004) independently increased the risk for chronic abdominal pain. Chronic pancreatitis
as indication for surgery (B = 4.20, P = .03), ≥3 previous abdominal operations (B = 1.03, P = .03), presence of pain >3 months before surgery (B = 1.61, P < .01), upper gastrointestinal tract as the anatomic location of surgery (B = 1.43, P = .03), and a higher preoperative GSRS score (B = .36, P < .01) independently increased the GSRS score 6 months after surgery. The duration
and severity of preoperative pain and more severe acute postoperative pain were the
most relevant risk factors for CPAP. The number of operations and the anatomic location
of the operation showed to be important risk factors for increasing the number of
gastrointestinal complaints.
Perspective: This prospective observational study shows the incidence and risk factors
for CPAP after major abdominal surgery. Preoperative pain-related factors were associated
with the occurrence of CPAP.
Key words
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Article info
Publication history
Published online: August 11, 2018
Accepted:
July 31,
2018
Received in revised form:
July 13,
2018
Received:
August 21,
2017
Footnotes
The authors have no conflicts of interest to declare.
Supplementary data accompanying this article are available online at www.jpain.org and www.sciencedirect.com.
Identification
Copyright
© 2018 by the American Pain Society
