Prevalence, characteristics and risk factors of chronic postsurgical pain after laparoscopic colorectal surgery Retrospective analysis

摘要

BACKGROUNDThe prevalence of chronic postsurgical pain (CPSP) is a critical medical problem with economic implications. Its prevalence after gastrointestinal surgery is not well documented, particularly when a laparoscopic approach is used.OBJECTIVEThe aim of the study was to determine the prevalence, the characteristics and the risk factors for CPSP after laparoscopic colorectal surgery.DESIGNA retrospective analysis using a postal questionnaire.SETTINGThe study was conducted at a university teaching hospital.PATIENTSPatients who underwent laparoscopic colorectal surgery from April 2008 until December 2011 (n=260). No epidural analgesia was used.MAIN OUTCOME MEASURESPostoperative pain intensity, incidence and characteristics of CPSP, and impact on quality of life and sleep.RESULTSOf 199 responses, 33 patients (17%) reported chronic pain at a median [interquartile range, IQR] of 38 [27 to 55] months after laparoscopic surgery with a median intensity of 4 [3 to 5]. CPSP had a negative impact on the quality of life in 84% of patients and on sleep in 43%. CPSP required regular analgesic(s) intake in 54% patients. Using a backward stepwise multivariate logistic regression model, the following variables were determined as independent risk factors for CPSP: redo surgery for anastomotic leakage (P=0.01), inflammatory bowel disease (IBD) as the indication for surgery (P=0.01) and preoperative pain (P=0.05).CONCLUSIONThe incidence of CPSP after laparoscopic colorectal surgery (17%) is similar to those reported in the literature after laparotomy. Risk factors are redo surgery for postoperative peritonitis, IBD and preoperative pain.TRIAL REGISTRATIONEudraCT 2012-005712-25.