Anesthesiology, V 122 • No 5 1103 May 2015 P OSTOPERATIVE pain after hysterectomy is a major issue contributing to patient discomfort, decreased patient satisfaction, risk for postoperative morbidity and mortality, and increasing medical costs due to extended hos- pital stays. 1,2 It has been estimated that there are 433,621 hysterectomies performed each year in the United States, 3 of which 12 to 17% are done for chronic pelvic pain. 4,5 With a large number of cases performed annually and the pos- sibility of same-day discharge for some patients undergoing hysterectomy, there are economic and patient-safety implica- tions in determining ways to avoid postoperative pain and any factors that lengthen hospital stays. It has been shown in a multicentered, retrospective study that factors predic- tive of severe acute postoperative pain include younger age, female sex, increased body mass index, preoperative surgical site pain severity, preoperative use of opioids, and general anesthesia. 6 Cognitive factors and pain coping strategies, such as pain catastrophizing, and mood disorders such as depression and anxiety have also been shown to infuence acute pain in patients undergoing hysterectomy. 2 What We Already Know about This Topic • Higher scores on the survey criteria for fbromyalgia question- naire have been shown to predict increased opioid consump- tion after arthroplasty although the generalizability of this has not been tested What This Article Tells Us That Is New • In 208 women undergoing hysterectomy, higher scores on a f- bromyalgia survey were independently associated with increased opioid consumption after accounting for known risk factors • This fbromyalgia survey may be useful in identifying individu- als at high risk for increased opioid consumption after surgery Copyright © 2015, the American Society of Anesthesiologists, Inc. Wolters Kluwer Health, Inc. All Rights Reserved. Anesthesiology 2015; 122:1103-11 ABSTRACT Background: Te current study was designed to test the hypothesis that the fbromyalgia survey criteria would be directly associated with increased opioid consumption after hysterectomy even when accounting for other factors previously described as being predictive for acute postoperative pain. Methods: Two hundred eight adult patients undergoing hysterectomy between October 2011 and December 2013 were phenotyped preoperatively with the use of validated self-reported questionnaires including the 2011 fbromyalgia survey cri- teria, measures of pain severity and descriptors, psychological measures, preoperative opioid use, and health information. Te primary outcome was the total postoperative opioid consumption converted to oral morphine equivalents. Results: Higher fbromyalgia survey scores were signifcantly associated with worse preoperative pain characteristics, including higher pain severity, more neuropathic pain, greater psychological distress, and more preoperative opioid use. In a multivariate linear regression model, the fbromyalgia survey score was independently associated with increased postoperative opioid con- sumption, with an increase of 7-mg oral morphine equivalents for every 1-point increase on the 31-point measure (Estimate, 7.0; Standard Error, 1.7; P < 0.0001). In addition to the fbromyalgia survey score, multivariate analysis showed that more severe medical comorbidity, catastrophizing, laparotomy surgical approach, and preoperative opioid use were also predictive of increased postoperative opioid consumption. Conclusions: As was previously demonstrated in a total knee and hip arthroplasty cohort, this study demonstrated that increased fbromyalgia survey scores were predictive of postoperative opioid consumption in the posthysterectomy surgical population during their hospital stay. By demonstrating the generalizability in a second surgical cohort, these data suggest that patients with fbromyalgia-like characteristics may require a tailored perioperative analgesic regimen. (ANESTHESIOLOGY 2015; 122:1103-11) This article is featured in “This Month in Anesthesiology,” page 1A. Corresponding article on page 967. Submitted for publication October 29, 2014. Accepted for publication January 30, 2015. From the Department of Anesthesiology, Vander- bilt University Medical Center, Nashville, Tennessee (A.M.J.); Department of Obstetrics and Gynecology, University of Michigan Health Sys- tem, Ann Arbor, Michigan (S.A.-S.); Department of Anesthesiology, University of Michigan Health System, Ann Arbor, Michigan (B.R., S.E.M., D.J.C., C.M.B.); and Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan (A.T.). Fibromyalgia Survey Criteria Are Associated with Increased Postoperative Opioid Consumption in Women Undergoing Hysterectomy Allison M. Janda, M.D., Sawsan As-Sanie, M.D., M.P.H., Baskar Rajala, M.D., M.B.B.S., F.R.C.A., Alex Tsodikov, Ph.D., Stephanie E. Moser, Ph.D., Daniel J. Clauw, M.D., Chad M. Brummett, M.D. PAIN MEDICINE Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/122/5/1103/485762/20150500_0-00026.pdf by guest on 03 July 2022