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Predicting Pain Levels Following Vaginal Reconstructive Surgery: Who Is at Highest Risk?

Shatkin-Margolis, Abigail, MD*†; Crisp, Catrina, C., MD, MSc*†; Morrison, Christopher, MD; Pauls, Rachel, N., MD*†

Female Pelvic Medicine & Reconstructive Surgery: March/April 2018 - Volume 24 - Issue 2 - p 172–175
doi: 10.1097/SPV.0000000000000522
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Objectives An ability to anticipate individuals at increased risk of postoperative pain would improve coordination of care and patient satisfaction. We sought to describe predictive factors of postoperative pain following vaginal reconstructive surgery.

Methods This institutional review board–approved, retrospective study used previously collected data from research performed at 1 center from 2009 to 2015. Eligible trials enrolled subjects undergoing vaginal reconstructive surgery for pelvic organ prolapse. All studies used a validated visual analog scale (VAS) for pain on postoperative day 1. Other information collected included pain medication use, medical and surgical history, and demographics. Linear regression analyses, multiple regression analyses, Mann-Whitney U, and Kruskal-Wallis tests were used to analyze the relationship between VAS scores and other variables.

Results Six studies were analyzed with a total of 364 patients. The median age was 60 years (interquartile range, 16 years), and the median pain score on postoperative day 1 was 35 mm on a 100-mm VAS. Patients younger than 60 years (P < 0.001), those who used tobacco (P = 0.014), those who used pain medication prior to surgery (P = 0.007), and those who did not have a concomitant midurethral sling (P = 0.018) had significantly higher pain scores postoperatively. A trend was also noted with operating times greater than 210 minutes (P = 0.057) and preexisting history of depression (P = 0.065). Multiple regression was performed, and age, depression, tobacco use, and concomitant sling were found to be independent factors predictive of postoperative pain scores.

Conclusions Age, depression, tobacco use, and concomitant midurethral sling are significant independent factors predictive of postoperative pain following vaginal reconstructive surgery.

From the *Division of Female Pelvic Medicine and Reconstructive Surgery, †Department of Obstetrics & Gynecology, Good Samaritan Hospital TriHealth, Cincinnati, OH.

Correspondence: Abigail Shatkin-Margolis, MD, Good Samaritan Hospital, 3219 Clifton Ave, Suite 100, Cincinnati, OH 45220. E-mail:

The authors have declared they have no conflicts of interest.

This study was registered at, NCT02996994.

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