de Cerqueira Joao Victor, Fermi Francesca, Shirzadi Samin, Olleik Ghadeer, Lapointe-Gagner Maxime, Jain Shrieda, Pook Makena, Dmowski Katy, Nguyen-Powanda Philip, Kaneva Pepa, Boutros Marylise, Lee Lawrence, Feldman Liane S, Fiore Julio F
Department of Surgery, McGill University, Montreal, QC, Canada.
Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
Surg Endosc. 2025 Sep 2. doi: 10.1007/s00464-025-12127-z.
Post-discharge pain management after colorectal surgery is challenging due to the multifactorial nature of pain and the risks of adverse events. Identifying modifiable factors associated with pain outcomes may help optimize care. This study aimed to assess the extent to which patient and care-related factors impact 7-day post-discharge pain outcomes after colorectal surgery.
This cohort study included adult patients undergoing elective colorectal surgery at two university-affiliated hospitals in Canada. Preoperative assessments included demographics, Pain Catastrophizing Scale, and PROMIS-29 anxiety and depression scales. 7-day post-discharge pain outcomes included PROMIS-29 pain intensity (range 0-10), pain interference (41.6-75.6), and satisfaction with pain management (high [10-9] vs. lower [8-0]). The association of potential predictors with pain outcomes was evaluated using Bayesian Model Averaging, with higher posterior effect probability (PEP) reflecting stronger evidence of association.
347 patients were included (59 ± 15 years, 53% male, 64% laparoscopic, 31% rectal resection, length of stay 3 days [IQR 2-5], same-day discharge 18%). At 7 days post-discharge, the median patient-reported pain intensity was 3/10 [1-4], pain interference was 58 [IQR 54-65], and 38% of patients reported lower satisfaction with pain management. Chronic pain was associated with greater pain intensity (β = 0.68; PEP = 78%) and lower satisfaction with pain management (OR = 1.72; PEP = 75%). Increased pain interference was associated with younger age (β = - 0.10; PEP = 98%), same-day discharge (β = 3.61; PEP = 86%), anxiety (β = 0.14; PEP = 71%), pain catastrophizing (β = 0.08; PEP = 66%), and female sex (β = 1.24; PEP = 54%). Depression predicted lower satisfaction (OR = 1.04; PEP = 81%), while TAP block use was associated with greater satisfaction (OR = 0.71; PEP = 52%).
In this study, post-discharge pain outcomes after colorectal surgery were generally positive, and influenced by an interplay of demographic, clinical, emotional, and care-related factors. These findings provide valuable insights to inform multifaceted strategies to improve pain outcomes and enhance patient experiences.
由于疼痛的多因素性质和不良事件风险，结直肠手术后出院后疼痛管理具有挑战性。识别与疼痛结局相关的可改变因素可能有助于优化护理。本研究旨在评估患者和护理相关因素对结直肠手术后出院7天疼痛结局的影响程度。
这项队列研究纳入了在加拿大两家大学附属医院接受择期结直肠手术的成年患者。术前评估包括人口统计学、疼痛灾难化量表以及PROMIS - 29焦虑和抑郁量表。出院7天的疼痛结局包括PROMIS - 29疼痛强度（范围0 - 10）、疼痛干扰（41.6 - 75.6）以及对疼痛管理的满意度（高[10 - 9]与低[8 - 0]）。使用贝叶斯模型平均法评估潜在预测因素与疼痛结局的关联，后验效应概率（PEP）越高表明关联证据越强。
共纳入347例患者（59±15岁，53%为男性，64%为腹腔镜手术，31%为直肠切除术，住院时间3天[四分位间距2 - 5]，18%为当日出院）。出院7天时，患者报告的疼痛强度中位数为3/10[1 - 4]，疼痛干扰为58[四分位间距54 - 65]，38%的患者对疼痛管理的满意度较低。慢性疼痛与更高的疼痛强度相关（β = 0.68；PEP = 78%）以及对疼痛管理的较低满意度相关（OR = 1.72；PEP = 75%）。疼痛干扰增加与年龄较小相关（β = - 0.10；PEP = 98%）、当日出院相关（β = 3.61；PEP = 86%）、焦虑相关（β = 0.14；PEP = 71%）、疼痛灾难化相关（β = 0.08；PEP = 66%）以及女性相关（β = 1.24；PEP = 54%）。抑郁预示着较低的满意度（OR = 1.04；PEP = 81%），而使用TAP阻滞与更高的满意度相关（OR = 0.71；PEP = 52%）。
在本研究中，结直肠手术后出院后疼痛结局总体良好，并受到人口统计学、临床、情绪和护理相关因素相互作用的影响。这些发现为制定多方面策略以改善疼痛结局和提升患者体验提供了有价值的见解。
