TY - JOUR
T1 - The Effect of Preoperative Disability, Cognitive Impairment, Frailty and Opioid Use on Acute Postoperative Pain in Older Patients Undergoing Surgery A Prospective Cohort Study
AU - Admiraal, Manouk
AU - van Zuylen, Mark L.
AU - Hermanns, Henning
AU - Willems, Hanna C.
AU - Geurtsen, Gert J.
AU - Steegers, Monique A. H.
AU - Kallewaard, Jan Willem
AU - Hollmann, Markus W.
AU - Hermanides, Jeroen
N1 - Funding Information: We would like to express our special thanks to Prof. Dr. A.H. Zwinderman whose statistical expertise was invaluable during the analyses. MA, MLZ, HH, and JH designed the study. MA, MLZ, GJG, and JH performed the research. MA, MLZ, HH, HC, GJG, MS, JWK, MWH, and JH assisted in reviewing the results. MA, MLZ, HH, HC, GJG, MS, JWW, MWH, and JH wrote the manuscript. MA, MLZ, HH, HC, GJG, MS, JWK, MWH, and JH critically evaluated the manuscript. The authors declare no conflict of interest regarding the submitted work. Outside the submitted manuscript, M.W.H. serves as Executive Section Editor Pharmacology with Anesthesia and Analgesia and Section Editor Anesthesiology with the Journal of Clinical Medicine, Editor with Frontiers in Physiology and he received speakers fees from PAION and IDD Pharma. This research received no specific grant from any funding agency. Publisher Copyright: © 2023 United States Association for the Study of Pain, Inc.
PY - 2023/10
Y1 - 2023/10
N2 - Globally, life expectancy is increasing, leading to more surgeries being performed in older patients. Postoperative pain is associated with complications after surgery. The aim of this study is to explore potential age-related risk factors for acute postoperative pain in older patients undergoing surgery. This was a prospective, single-center study. Patients ≥65 years, with and without disability, as defined by the WHO Disability Assessment Schedule 2.0, undergoing elective surgery, were compared. Primary outcome was the postoperative pain (ie, numeric rating scale (NRS) score) on the first postoperative day. Secondary outcomes were postoperative pain and pain trajectories in patients with and without mild cognitive impairment (MCI), frailty, preoperative opioid use, and new-onset disability after surgery. Between February 2019 and July 2020, 155 patients were enrolled. On the first day after surgery, postoperative pain did not differ between patients with and without disability. NRS scores differed between patients with-, and without MCI on the first (P =.01), and second postoperative day (P <.01). Patients who used opioids before surgery reported higher median NRS score on the first (P <.001) and second (P <.01) postoperative day. Out of a total of 1816 NRS scores, 2 pain clusters were identified. Acute postoperative pain did not differ between patients with or without preoperative disability and frailty in older patients undergoing surgery. Reduced postoperative pain in older patients with MCI warrants further investigation. The PIANO study (Comparison of Postoperative NeurocognitiveFunction in Older Adult Patients with and without Diabetes Mellitus) was registered with www.clinicaltrialregister.nl (search term: Which can predict memory problems after surgery better; blood sugar levels or memory before surgery?). Perspective: This study explored risk factors for acute postoperative pain in older patients. No differences in postoperative pain were observed in patients with or without preexistent disability or frailty, however, patients with mild cognitive impairment experienced reduced pain. We suggest to simplify pain assessment in this group and take functional recovery into account.
AB - Globally, life expectancy is increasing, leading to more surgeries being performed in older patients. Postoperative pain is associated with complications after surgery. The aim of this study is to explore potential age-related risk factors for acute postoperative pain in older patients undergoing surgery. This was a prospective, single-center study. Patients ≥65 years, with and without disability, as defined by the WHO Disability Assessment Schedule 2.0, undergoing elective surgery, were compared. Primary outcome was the postoperative pain (ie, numeric rating scale (NRS) score) on the first postoperative day. Secondary outcomes were postoperative pain and pain trajectories in patients with and without mild cognitive impairment (MCI), frailty, preoperative opioid use, and new-onset disability after surgery. Between February 2019 and July 2020, 155 patients were enrolled. On the first day after surgery, postoperative pain did not differ between patients with and without disability. NRS scores differed between patients with-, and without MCI on the first (P =.01), and second postoperative day (P <.01). Patients who used opioids before surgery reported higher median NRS score on the first (P <.001) and second (P <.01) postoperative day. Out of a total of 1816 NRS scores, 2 pain clusters were identified. Acute postoperative pain did not differ between patients with or without preoperative disability and frailty in older patients undergoing surgery. Reduced postoperative pain in older patients with MCI warrants further investigation. The PIANO study (Comparison of Postoperative NeurocognitiveFunction in Older Adult Patients with and without Diabetes Mellitus) was registered with www.clinicaltrialregister.nl (search term: Which can predict memory problems after surgery better; blood sugar levels or memory before surgery?). Perspective: This study explored risk factors for acute postoperative pain in older patients. No differences in postoperative pain were observed in patients with or without preexistent disability or frailty, however, patients with mild cognitive impairment experienced reduced pain. We suggest to simplify pain assessment in this group and take functional recovery into account.
KW - Older patient
KW - acute postoperative pain
KW - disability
KW - mild cognitive impairment
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85163849548&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jpain.2023.05.013
DO - https://doi.org/10.1016/j.jpain.2023.05.013
M3 - Article
C2 - 37270141
SN - 1526-5900
VL - 24
SP - 1886
EP - 1895
JO - Journal of Pain
JF - Journal of Pain
IS - 10
ER -