Anesthesiology, V 120 • No 5 1237 May 2014 S OME 240 million surgical procedures are performed annually worldwide. 1 Severe pain after surgical procedures is a major factor causing patients’ dissatisfaction, delayed recov- ery, immobility, and prolonged hospital stay in the postopera- tive period and is associated with severe complications, such as chronic pain. 2,3 A recent study indicated that severe pain is an issue not only after major but also after many minor surger- ies. 4 Optimal perioperative pain management is not only an ethical but also a medical as well as an economic issue. Much efort has been made to improve postoperative pain treatment: implementing guidelines on postoperative pain, providing acute pain services, and increasing the use of regional anesthe- sia techniques are known to be the most efective eforts for reducing postsurgical pain. Despite these eforts, many patients continue to sufer severe postoperative pain. 3,5,6 Some major reasons for this unsatisfactory situation have recently been elucidated, one of them being that diferent surgical procedures may have diferent mechanisms which produce pain and pain-related consequences. Terefore, surgical procedure–specifc pain treatment is regarded as the next step toward further improvement of pain manage- ment. 7–9 Another problem is that some patients may present certain risk factors for developing more severe postoperative pain than others. 10 Te identifcation of patients at risk may help to permit efective treatment strategies to be initiated at an early stage to prevent severe pain in these patients. What We Already Know about This Topic • Although predictors of severity of acute postoperative pain have been previously examined, no study has examined pre- dictors across a large dataset of multiple surgical procedures What This Article Tells Us That Is New • In a review of over 22,000 German patients across a wide variety of surgical procedures, predictors of severity of acute postoperative pain were reproducible • Younger age, female sex, and preoperative pain intensity all were associated with statistically signifcant, but small increas- es in postoperative pain across procedures Copyright © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins. Anesthesiology 2014; 120:1237-45 ABSTRACT Background: Many studies have analyzed risk factors for the development of severe postoperative pain with contradictory results. To date, the association of risk factors with postoperative pain intensity among diferent surgical procedures has not been studied and compared. Methods: Te authors selected precisely defned surgical groups (at least 150 patients each) from prospectively collected peri- operative data from 105 German hospitals (2004–2010). Te association of age, sex, and preoperative chronic pain intensity with worst postoperative pain intensity was studied with multiple linear and logistic regression analyses. Pooled data of the selected surgeries were studied with random-efect analysis. Results: Tirty surgical procedures with a total number of 22,963 patients were compared. In each surgical procedure, pre- operative chronic pain intensity and younger age were associated with higher postoperative pain intensity. A linear decline of postoperative pain with age was found. Females reported more severe pain in 21 of 23 surgeries. Analysis of pooled surgical groups indicated that postoperative pain decreased by 0.28 points (95% CI, 0.26 to 0.31) on the numeric rating scale (0 to 10) per decade age increase and postoperative pain increased by 0.14 points (95% CI, 0.13 to 0.15) for each higher score on the preoperative chronic pain scale. Females reported 0.29 points (95% CI, 0.22 to 0.37) higher pain intensity. Conclusions: Independent of the type and extent of surgery, preoperative chronic pain and younger age were associated with higher postoperative pain. Females consistently reported slightly higher pain scores regardless of the type of surgery. Te clinical signifcance of this small sex diference has to be analyzed in future studies. (ANESTHESIOLOGY 2014; 120:1237-45) Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www. anesthesiology.org). Submitted for publication May 15, 2013. Accepted for publication November 8, 2013. From the Department of Anesthesiology and Inten- sive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands (H.J.G., A.J.M.v.W., L.M.P., T.H.K., and C.J.K.); Department of Anesthesiology, Intensive Care Medicine, and Pain Therapy, University of Münster, Münster, Germany (E.P.-Z.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (L.M.P.); Department of Anesthesiology and Inten- sive Care Medicine, University of Cologne, Cologne, Germany (S.A.); and Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany (W.M.). Procedure-specific Risk Factor Analysis for the Development of Severe Postoperative Pain Hans J. Gerbershagen, M.D., Ph.D., Esther Pogatzki-Zahn, M.D., Ph.D., Sanjay Aduckathil, M.D., Linda M. Peelen, Ph.D., Teus H. Kappen, M.D., Albert J. M. van Wijck, M.D., Ph.D., Cor J. Kalkman, M.D., Ph.D., Winfried Meissner, M.D., Ph.D. Downloaded from http://pubs.asahq.org/anesthesiology/article-pdf/120/5/1237/265361/20140500_0-00033.pdf by guest on 13 January 2022