Retrospective chart review of surgical patients and chronic pain
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Citation
Abstract
BACKGROUND: Chronic postsurgical pain (CPSP) affects 10-30% of surgical patients and is associated with prolonged suffering, which may lead to a diminished quality of life (QOL). Thus, efforts to mitigate the incidence of CPSP have expanded, focusing on identifying risk factors and using new medical inventions. One recent advancement focuses on using functional near-infrared spectroscopy (fNIRS) as a brain biomarker to assess nociception during surgery. The goal of this technique is to help guide perioperative pain management strategies to mitigate CPSP. However, there are still many gaps in our understanding of what risk factors have direct effects on CPSP, requiring further exploration of its complexities and identification of the factors influencing its occurrence. This thesis aims to explore the multifaceted nature of CPSP by creating a retrospective chart review of surgical patients to understand standard demographics, preexisting health conditions, and surgical factors that may increase the incidence of CPSP.
METHODS: This study focused on exploring the incidence of CPSP in two distinct groups: patients who underwent a hernia surgery and patients who underwent a cardiac surgery. A total of 100 patients were selected, and within each surgical cohort, 50 patients were included and divided into CPSP or No CPSP groups based on self-reported new or worsened pain that persisted for three or more months following their surgical procedure. The CPSP and No CPSP groups for each surgical type were then compared against each other using prevalence rates and statistical measures based on three variables: demographics, preexisting conditions, and surgical factors. To ensure a comprehensive analysis, outliers were identified and removed. Thus, 41 hernia surgical patients (n= 11 CPSP, n= 30 No CPSP) and 50 cardiac surgical patients (11 = CPSP and 39 = No CPSP) were included in the final analysis.
RESULTS: The prevalence rates of CPSP for the cardiac surgical group and hernia surgical group was 11 and 17 patients, respectively. After removing outliers from the hernia surgical group, the prevalence rate for the CPSP group was 11 patients. Among the hernia surgical group, the prevalence of pre-existing pain, surgical history, cardiovascular, and cancer conditions seemed to be greater for those with CPSP. Specifically, the odds of someone developing CPSP with a history of cancer was 4.1 times greater than someone without a prior cancer diagnosis (χ2(1,41) =3.617, p=0.057, Odds ratio=4.1). Additionally, patients with three or more prior conditions were 6.2 times at greater odds of developing CPSP than those without these conditions (χ2(1,41) =6.05, p=0.01, Odds ratio=6.2). When analyzing the cardiac surgical group, data revealed that both the pre-operative and postoperative pain levels on average were greater for the CPSP group (2.9 ± 2.5 and 3.3 ± 3.2, respectively) when compared to the No CPSP group (1.7 ± 2.1 and 1.8 ± 2.2, respectively). This data was supported by a medium effect size for the preoperative pain levels (t (48) = -1.61, p=0.112, Cohen’s d=0.46) and post-operative pain levels (t (48) = -1.73, p=0.08, Cohen’s d=0.499). Similarly, though the results were not statistically significant for preexisting pain (p=0.823) and prior surgeries (p=0.494), the prevalence was greater for both variables in the CPSP group compared to the No CPSP group. Further comparing the total number of pre-existing conditions per patient showed no notable differences between the CPSP and No CPSP groups (t (48) = 0.22, p=0.826, Cohen’s d=0.078).
CONCLUSION: We observed significant relationships between the incidence of developing CPSP and pre-existing conditions, such as cancer and having three or more premorbid conditions. Thus, highlighting the importance of addressing risk factors before surgical intervention. However, the study is limited by the small sample size thus future research with a larger sample pool may expand this relationship to provide more conclusive evidence as to which risk factors contribute to an increased risk of CPSP. Additionally, since this is a retrospective chart review, looking at longitudinal studies can help understand the transition from postsurgical acute to chronic pain development.
Description
2024