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Observational Study
. 2019 Mar 1;20(3):543-554.
doi: 10.1093/pm/pny096.

Preoperative Patient Expectations of Postoperative Pain Are Associated with Moderate to Severe Acute Pain After VATS

Emine Ozgur Bayman  1   2 , Kalpaj R Parekh  3 , John Keech  3 , Nyle Larson  1 , Mark Vander Weg  4 , Timothy J Brennan  1   5
Affiliations
Observational Study

Preoperative Patient Expectations of Postoperative Pain Are Associated with Moderate to Severe Acute Pain After VATS

Emine Ozgur Bayman et al. Pain Med. .

Abstract

Objective: The goal of this post hoc analysis of subjects from a prospective observational study was to identify the predictors of patients developing moderate to severe acute pain (mean numerical rating scale [NRS] ≥4, 0-10) during the first three days after video-assisted thoracoscopic surgery (VATS) from a comprehensive evaluation of demographic, psychosocial, and surgical factors.

Methods: Results from 82 patients who were enrolled one week before VATS and evaluated during the first three postoperative days are presented. The primary outcome variable of the current study was the presence of moderate to severe acute pain after VATS.

Results: Fifty-nine percent (95% confidence interval, 47-69%) of study subjects developed moderate to severe acute pain after VATS. Factors univariately associated with the presence of moderate to severe acute pain were greater average expected postoperative pain, greater pain to a suprathreshold cold stimulus, and longer durations of surgery and hospital stay (P < 0.05). When considered in the multiple logistic regression models, the patients' preoperative average intensity of expected postoperative pain (NRS, 0-10) was the only measure associated with the moderate to severe acute pain. Average intensity of postoperative pain expected by patients when questioned preoperatively mediated the effect of reported intensity of pain to the suprathreshold cold stimulus for moderate to severe acute pain levels. Preoperative patient expectations had greater predictive value than other assessed variables including psychosocial factors such as catastrophizing or anxiety assessed one week before surgery.

Conclusions: None of the preoperative psychosocial measures were associated with the moderate to severe acute pain after VATS. Average expected postoperative pain was the only measure associated with the development of moderate to severe acute pain after VATS.

Keywords: Acute Pain; Multiple Logistic Regression; Predictors; Thoracic Surgery; VATS.

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Figures

Figure 1
Figure 1
Flowchart of patients. MRI = magnetic resonance imaging; VATS = video-assisted thoracoscopic surgery.
Figure 2
Figure 2
The average postoperative pain score was calculated as the mean of the pain scores from three postoperative days. Moderate to severe acute pain was defined when the average postoperative pain score (numerical rating scale [NRS], 0–10) was ≥4, represented with circles in the figure. Those patients with average postoperative pain score <4 (mild acute pain) are represented with triangles. Note that some patients may have daily pain scores <4 on postoperative days 1, 2, or 3, but with an average postoperative pain score ≥4. For example, see the circles on POD 3 below the NRS line of 4.0. POD = postoperative day.
Figure 3
Figure 3
Average expected vs average observed postoperative pain severity scores during the first three days after VATS. NRS = numerical rating scale; POD = postoperative day.
See this image and copyright information in PMC

References

    1. The Society of Thoracic Surgeons. The Society of Thoracic Surgeons General Thoracic Surgery Database. Chicago: The Society of Thoracic Surgeons; 2011.
    1. Dziedzic D, Orlowski T.. The role of VATS in lung cancer surgery: Current status and prospects for development. Minim Invasive Surg 2015;2015:938430.. - PMC - PubMed
    1. The Society of Thoracic Surgeons. The Society of Thoracic Surgeons General Thoracic Surgery Database, 2016. Chicago, IL: The Society of Thoracic Surgeons; 2017.
    1. Whitson BA, Andrade RS, Boettcher A, et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for resection of clinical stage I non-small cell lung cancer. Ann Thorac Surg 2007;836:1965–70. - PubMed
    1. Hanna WC, de Valence M, Atenafu EG, et al. Is video-assisted lobectomy for non-small-cell lung cancer oncologically equivalent to open lobectomy? Eur J Cardiothorac Surg 2013;436:1121–5. - PubMed

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