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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (5): 851-856. doi: 10.19723/j.issn.1671-167X.2023.05.012

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Factors influencing the chronic post-surgical pain after laparoscopic surgery for elderly patients with urinary tract tumors

Hui-li LIU1,Yan-han LV1,Xiao-xiao WANG2,Min LI1,*()   

  1. 1. Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
    2. Clinical Epidemiology Research Center, Peking University Third Hospital, Beijing 100191, China
  • Received:2023-04-03 Online:2023-10-18 Published:2023-10-09
  • Contact: Min LI E-mail:liminanesth@bjmu.edu.cn

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Abstract:

Objective: To investigate the incidence and potential influence factors that contribute to chronic post-surgical pain (CPSP) in elderly patients with urinary tract tumors who underwent laparoscopic procedures. Methods: A retrospective study was conducted to collect the clinical data of 182 elderly patients with urinary tract tumors who were ≥65 years and underwent laparoscopic surgery from October 2021 to March 2022 in Peking University Third Hospital. The patients'demographic information, medical history and the severity of postoperative pain were collected. Telephone follow-ups were made 6 months after surgery, and the patients' CPSP conditions were recorded. The diagnostic criteria of CPSP were referred to the definition made by the International Association for the Study of Pain (IASP): (1) Pain that developed or increased in intensity after surgical procedure and persisted for at least 3 months after surgery; (2) Pain that localized to the surgical field or projected to the innervation territory of a nerve situated around the surgical area; (3) Pain due to pre-existing pain conditions or infections and malignancy was excluded. The patients were divided into two groups based on CPSP diagnosis. Risk factors that predisposed the patients to CPSP were identified using univariate analysis. A multivariate Logistic regression model using back-forward method was designed, including both variables that significantly associated with CPSP in the univariate analysis (P < 0.1), and the variables that were considered to have significant clinical impact on the outcome. Results: Two hundred and sixteen patients with urinary tract tumors who had undergone laparoscopic surgery were included, of whom, 34 (15.7%) were excluded from the study. For the remaining 182 patients, the average age was (72.6±5.2) years, with 146 males and 36 females. The incidence of CPSP at the end of 6 months was 31.9% (58/182). Multiva-riate regression analysis revealed that age ≥75 years (OR=0.29, 95% CI: 0.12-0.73, P=0.008) was the protecting factors for postoperative chronic pain in the elderly patients with urinary tract tumors undergoing surgical treatment, while renal cancer (compared with other types of urinary tract tumors) (OR=3.68, 95% CI: 1.58-8.58, P=0.003), and the 24 h postoperative moderate to severe pain (OR=2.57, 95% CI: 1.14-5.83, P=0.024) were the independent risk factors affecting CPSP. Conclusion: Age < 75 years, renal cancer and the 24 h postoperative moderate to severe pain are influence factors of the occurrence of CPSP after laparoscopic surgery in elderly patients with urinary tract tumors. Optimum postoperative multimodal analgesia strategies are suggested to prevent the occurrence of CPSP.

Key words: Urologic neoplasms, Pain, postoperative, Chronic pain, Laparoscopy, Aged

CLC Number: 

  • R441.1

Table 1

Basement characteristics and univariate analysis between non-CPSP and CPSP group [n (%)]"

Variables Non-CPSP (n=124) CPSP (n=58) χ2 P
Gender 1.811 0.178
    Male 103 (83.1) 43 (74.1)
    Female 21 (16.9) 15 (25.9)
Age 6.623 0.010
    65-74 years old 65 (52.4) 43 (74.1)
    ≥75 years old 59 (47.6) 15 (25.9)
Body mass index>24 kg/m2 71 (57.3) 27 (46.6) 0.125 0.723
ASA grade 0.716 0.699
    Ⅰ 15 (12.1) 5 (8.6)
    Ⅱ 78 (62.9) 39 (67.3)
    Ⅲ 31 (25.0) 14 (24.1)
Diagnosis 12.005 0.017
    Renal cancer 26 (21.0) 27 (46.6)
    Bladder cancer 13 (10.5) 6 (10.3)
    Renal pelvis cancer 8 (6.5) 2 (3.4)
    Prostatic cancer 62 (50.0) 21 (36.2)
    Ureteral cancer 15 (12.0) 2 (3.4)
Comorbidities
    Hypertension 52 (41.9) 28 (48.3) 0.489 0.484
    Diabetes 19 (15.3) 15 (25.9) 2.761 0.097
    Cardiovascular disease 27 (21.8) 10 (17.2) 0.235 0.268
    Cerebrovascular disease 10 (8.1) 8 (13.8) 1.479 0.224
Past history
    History of surgery 65 (52.4) 32 (55.2) 0.184 0.668
    History of smoking 38 (30.6) 20 (34.5) 0.236 0.627
    History of drinking 21 (16.9) 13 (22.4) 0.573 0.449
    Chronic preoperative pain 34 (27.4) 25 (43.1) 5.763 0.016
Peripheral nerve block 43 (34.7) 15 (25.9) 1.405 0.236
Patient controlled intravenous analgesia 52 (41.9) 22 (37.9) 0.042 0.837
Moderate to severe pain within 24 h postoperatively 58 (46.8) 37 (63.8) 3.707 0.054
Duration of surgery>2 h 87 (70.2) 36 (62.1) 1.018 0.313
Blood loss>100 mL 36 (29.0) 8 (13.8) 3.628 0.057
Admission to ICU 15 (12.1) 5 (8.6) 0.464 0.496
Length of hospital stay>8 d 57 (46.0) 23 (40.0) 0.403 0.526

Table 2

Multivariate analysis of risk factors of CPSP after laparoscopic surgery for elderly patients with urinary tract tumors"

Variables OR 95% CI P
Age≥75 years 0.29 0.12-0.73 0.008
Renal cancer* 3.68 1.58-8.58 0.003
Diabetes 2.03 0.74-5.58 0.169
Blood loss>100 mL 1.43 0.51-1.56 0.111
Chronic preoperative pain 2.08 0.87-5.39 0.073
Moderate to severe pain within 24 h postoperatively 2.57 1.14-5.83 0.024
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