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Prevalence and Predictive Factors of Chronic Postsurgical Pain and Poor Global Recovery 1 Year After Outpatient Surgery

Hoofwijk, Daisy M. N. MD*; Fiddelers, Audrey A. A. PhD*; Peters, Madelon L. PhD; Stessel, Björn MD; Kessels, Alfons G. H. MD, MSc§; Joosten, Elbert A. PhD*; Gramke, Hans-Fritz MD, PhD*; Marcus, Marco A. E. MD, PhD*,∥

doi: 10.1097/AJP.0000000000000207
Original Articles

Objectives: To prospectively describe the prevalence and predictive factors of chronic postsurgical pain (CPSP) and poor global recovery in a large outpatient population at a university hospital, 1 year after outpatient surgery.

Materials and Methods: A prospective longitudinal cohort study was performed. During 18 months, patients presenting for preoperative assessment were invited to participate. Outcome parameters were measured by using questionnaires at 3 timepoints: 1 week preoperatively, 4 days postoperatively, and 1 year postoperatively. A value of >3 on an 11-point numeric rating scale was considered to indicate moderate to severe pain. A score of ≤80% on the Global Surgical Recovery Index was defined as poor global recovery.

Results: A total of 908 patients were included. The prevalence of moderate to severe preoperative pain was 37.7%, acute postsurgical pain 26.7%, and CPSP 15.3%. Risk factors for the development of CPSP were surgical specialty, preoperative pain, preoperative analgesic use, acute postoperative pain, surgical fear, lack of optimism, and poor preoperative quality of life. The prevalence of poor global recovery was 22.3%. Risk factors for poor global recovery were recurrent surgery because of the same pathology, preoperative pain, preoperative analgesic use, surgical fear, lack of optimism, poor preoperative and acute postoperative quality of life, and follow-up surgery during the first postoperative year.

Discussion: Moderate to severe CPSP after outpatient surgery is common, and should not be underestimated. Patients at risk for developing CPSP can be identified during the preoperative phase.

Departments of *Anesthesiology and Pain Treatment

§Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+(a.k.a. MUMC+)

Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands

Department of Anaesthesiology, Jessa Hospital, Hasselt, Belgium

Department of Anesthesiology, ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar

Data collection, statistical analyses, data interpretation, figure creation, and writing of the paper: D.M.N.H. Study design, data collection, statistical analysis, data interpretation, and writing of the paper: A.A.A.F. Study design and writing of the paper: M.L.P. Writing of the paper: B.S. Writing of the paper: E.A.J. Study design, data interpretation, and writing of the paper: H.-F.G. Study design, data interpretation, and writing of the paper: M.A.E.M.

The department of anaesthesiology of the Maastricht University Medical Center+ received payments of Grunenthal for consultancy activities on Tapentadol of M.A.E.M. The remaining authors declare no conflict of interest.

Reprints: Daisy M. N. Hoofwijk, MD, Departments of Anesthesiology and Pain Treatment, Maastricht University Medical Center+, P.O. Box 5800, Maastricht 6202 AZ, The Netherlands (e-mail:

Received August 11, 2014

Received in revised form January 29, 2015

Accepted December 20, 2014

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