Background

Persistent post-surgical pain is an important and under-recognised problem that is difficult to treat. Postoperative complications have been identified as possible risk factors for persistent post-surgical pain. We conducted a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) cohort study to characterise the association of major postoperative complications with post-surgical pain at 30 days and 1 yr after major surgery.

Methods

The analysis included 1313 participants (≥40 yr old) who had inpatient noncardiac surgery and survived for 1 yr. The co-primary outcomes were 30-day post-surgical pain and 1-yr post-surgical pain. Post-surgical pain was defined as pain or discomfort that was of moderate or severe intensity (EuroQoL-5D [EQ-5D] instrument) and unimproved compared with preoperative pain or discomfort. The principal exposure was major in-hospital complications (moderate or severe by modified Clavien–Dindo criteria). Multivariable logistic regression modelling was used to characterise the adjusted association of major complications with outcomes.

Results

Of the cohort, 12% (n=163) experienced major complications, 51% (n=674) reported 30-day post-surgical pain, and 42% (n=545) reported 1-yr post-surgical pain. Major complications were associated with 30-day post-surgical pain (adjusted odds ratio [aOR]=1.54; 95% confidence interval [CI], 1.05–2.23) and possibly 1-yr post-surgical pain (aOR=1.42; 95% CI, 0.98–2.06). When analyses were repeated after multiple imputation of missing covariate and outcome data, complications were associated with both 30-day and 1-yr post-surgical pain.

Conclusions

Patients who developed major complications were more likely to report pain at 30 days and possibly 1 yr after surgery. Research is necessary to validate these findings and delineate underlying mechanisms.

中文翻译：

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术后并发症与术后持续疼痛的关联：一项多中心前瞻性队列研究

背景

持续性术后疼痛是一个重要且未被充分认识的问题，难以治疗。术后并发症已被确定为术后持续疼痛的可能危险因素。我们对手术前运动耐受测量 (METS) 队列研究进行了二次分析，以描述主要术后并发症与大手术后 30 天和 1 年术后疼痛的关系。

方法

该分析包括 1313 名参与者（≥40 岁），他们接受了住院非心脏手术并存活了 1 年。共同主要结果是术后 30 天的疼痛和术后 1 年的疼痛。术后疼痛被定义为中度或重度强度的疼痛或不适（EuroQoL-5D [EQ-5D] 仪器）并且与术前疼痛或不适相比没有改善。主要暴露是主要的院内并发症（根据改良的 Clavien-Dindo 标准为中度或重度）。多变量逻辑回归模型用于表征主要并发症与结果的调整关联。

结果

在该队列中，12% ( n =163) 出现严重并发症，51% ( n =674) 报告术后 30 天疼痛，42% ( n =545) 报告术后 1 年疼痛。主要并发症与术后 30 天疼痛（调整优势比 [aOR]=1.54；95% 置信区间 [CI]，1.05-2.23）和可能的术后 1 年疼痛（aOR=1.42；95% CI，0.98–2.06）。在对缺失的协变量和结果数据进行多重插补后重复分析时，并发症与术后 30 天和 1 年的疼痛相关。

结论

出现严重并发症的患者更有可能在术后 30 天和可能 1 年后出现疼痛。有必要进行研究以验证这些发现并描述潜在的机制。