Email Alert | RSS

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

Previous Articles     Next Articles

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

RICH HTML

   

PDF (PC)

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
1 Walker SM . Developmental mechanisms of CPSP: Clinical observations and translational laboratory evaluations[J]. Can J Pain, 2021, 6 (2): 49- 60.
2 Fletcher D , Stamer UM , Pogatzki-Zahn E , et al. Chronic postsurgical pain in Europe: An observational study[J]. Eur J Anaesthesiol, 2015, 32 (10): 725- 734.
doi: 10.1097/EJA.0000000000000319
3 Sharma LR , Schaldemose EL , Alaverdyan H . Perioperative factors associated with persistent postsurgical pain after hysterectomy, cesarean section, prostatectomy, and donor nephrectomy: A syste-matic review and meta-analysis[J]. Pain, 2022, 163 (3): 425- 435.
doi: 10.1097/j.pain.0000000000002361
4 Esses G , Deiner S , Ko F , et al. Chronic post-surgical pain in the frail older adult[J]. Drugs Aging, 2020, 37 (5): 321- 329.
doi: 10.1007/s40266-020-00761-2
5 Schug SA , Lavand'homme P , Barke A , et al. IASP taskforce for the classification of chronic pain. The IASP classification of chro-nic pain for ICD-11: Chronic postsurgical or posttraumatic pain[J]. Pain, 2019, 160 (1): 45- 52.
doi: 10.1097/j.pain.0000000000001413
6 Owen M , Lorgelly P , Serpell M . Chronic pain following donor nephrectomy: A study of the incidence, nature and impact of chronic post-nephrectomy pain[J]. Eur J Pain, 2010, 14 (7): 732- 734.
doi: 10.1016/j.ejpain.2009.11.013
7 Macrae WA . Chronic post-surgical pain: 10 years on[J]. Br J Anaesth, 2008, 101 (1): 77- 86.
doi: 10.1093/bja/aen099
8 Glare P , Aubrey KR , Myles PS . Transition from acute to chronic pain after surgery[J]. Lancet, 2019, 393 (10180): 1537- 1546.
doi: 10.1016/S0140-6736(19)30352-6
9 Alper I , Yüksel E . Comparison of acute and chronic pain after open nephrectomy versus laparoscopic nephrectomy: A prospective clinical trial[J]. Medicine, 2016, 95 (16): e3433.
doi: 10.1097/MD.0000000000003433
10 Wang J , Fu Y , Yuan T , et al. Comparison of postoperative analgesic requirements in living donors and patients undergoing similar surgical procedures[J]. Transplant Proc, 2015, 47 (6): 1896- 1900.
doi: 10.1016/j.transproceed.2015.04.088
11 Lopes A , Seligman Menezes M , Antonio Moreira de Barros G . Chronic postoperative pain: Ubiquitous and scarcely appraised: narrative review[J]. Braz J Anesthesiol, 2021, 71 (6): 649- 655.
12 van Helden EV , van Uitert A , Albers KI , et al. Chronic postsurgical pain after minimally invasive adrenalectomy: Prevalence and impact on quality of life[J]. BMC Anesthesiol, 2022, 22 (1): 153.
doi: 10.1186/s12871-022-01696-4
13 Tinnirello A , Mazzoleni S , Santi C . Chronic pain in the elderly: Mechanisms and distinctive features[J]. Biomolecules, 2021, 11 (8): 1256.
doi: 10.3390/biom11081256
14 Jaroudi W , Garami J , Garrido S , et al. Factors underlying cognitive decline in old age and Alzheimer's disease: The role of the hippocampus[J]. Rev Neurosci, 2017, 28 (7): 705- 714.
doi: 10.1515/revneuro-2016-0086
15 Artus M , Laviolle B , Maurice A , et al. Risk factors for persistent pain after urological surgery[J]. Ann Fr Anesth Reanim, 2014, 33 (5): e89- e94.
doi: 10.1016/j.annfar.2014.03.013
16 Tsai HJ , Chang WK , Yen FY , et al. Influential factors and personalized prediction model of acute pain trajectories after surgery for renal cell carcinoma[J]. J Pers Med, 2022, 12 (3): 360.
doi: 10.3390/jpm12030360
17 Blute ML , Leibovich BC , Lohse CM , et al. The Mayo clinic experience with surgical management, complications and outcome for patients with renal cell carcinoma and venous tumour thrombus[J]. BJU Int, 2004, 94 (1): 33- 41.
doi: 10.1111/j.1464-410X.2004.04897.x
18 Katz J , Seltzer Z . Transition from acute to chronic postsurgical pain: Risk factors and protective factors[J]. Expert Rev Neuro-ther, 2009, 9 (5): 723- 744.
doi: 10.1586/ern.09.20
19 Bruintjes MHD , van Helden EV , de Vries M , et al. Chronic pain following laparoscopic living-donor nephrectomy: Prevalence and impact on quality of life[J]. Am J Transplant, 2019, 19 (10): 2825- 2832.
doi: 10.1111/ajt.15350
20 Chen YK , Boden KA , Schreiber KL . The role of regional anaesthesia and multimodal analgesia in the prevention of chronic postoperative pain: A narrative review[J]. Anaesthesia, 2021, 76 (S1): 8- 17.
doi: 10.1111/anae.15256
21 van Reij RRI , Joosten EAJ , van den Hoogen NJ . Dopaminergic neurotransmission and genetic variation in chronification of post-surgical pain[J]. Br J Anaesth, 2019, 123 (6): 853- 864.
doi: 10.1016/j.bja.2019.07.028
22 Covotta M , Claroni C , Costantini M , et al. The effects of ultrasound-guided transversus abdominis plane block on acute and chronic postsurgical pain after robotic partial nephrectomy: A prospective randomized clinical trial[J]. Pain Med, 2020, 21 (2): 378- 386.
doi: 10.1093/pm/pnz214
23 Tsirline VB , Colavita PD , Belyansky I , et al. Preoperative pain is the strongest predictor of postoperative pain and diminished quality of life after ventral hernia repair[J]. Am Surg, 2013, 79 (8): 829- 836.
doi: 10.1177/000313481307900828
24 Gerbershagen HJ , Ozgur E , Dagtekin O , et al. Preoperative pain as a risk factor for chronic post-surgical pain-six month follow-up after radical prostatectomy[J]. Eur J Pain, 2009, 13 (10): 1054- 1061.
doi: 10.1016/j.ejpain.2008.11.020
[1] Haoyu ZHANG,Yiwen SHI,Wei PAN,Aiping LIU,Xinying SUN,Man LI,Xuxi ZHANG. Factors associated with the care needs of the older adults based on different disability levels [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 431-440.
[2] Ting JING,Hua JIANG,Ting LI,Qianqian SHEN,Lan YE,Yindan ZENG,Wenxin LIANG,Gang FENG,Man-Yau Szeto Ignatius,Yumei ZHANG. Relationship between serum 25-hydroxyvitamin D and handgrip strength in middle-aged and elderly people in five cities of Western China [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 448-455.
[3] Yuting LIN,Huali WANG,Yu TIAN,Litong GONG,Chun CHANG. Factors influencing cognitive function among the older adults in Beijing [J]. Journal of Peking University (Health Sciences), 2024, 56(3): 456-461.
[4] Huameng TANG,Dianqi YUAN,Mingxing WANG,Hanbing YANG,Chao GUO. Sequential mediating role of digital participation and health lifestyle in the relationship between socioeconomic status and depression of older adults [J]. Journal of Peking University (Health Sciences), 2024, 56(2): 230-238.
[5] Min QIU,You-long ZONG,Bin-shuai WANG,Bin YANG,Chu-xiao XU,Zheng-hui SUN,Min LU,Lei ZHAO,Jian LU,Cheng LIU,Xiao-jun TIAN,Lu-lin MA. Treatment outcome of laparoscopic partial nephrectomy in patients with renal tumors of moderate to high complexity [J]. Journal of Peking University (Health Sciences), 2023, 55(5): 833-837.
[6] Chun-su ZHU,Zhi-wei LIAN,Yi-min CUI. Association between depression and chronic diseases among middle-aged and older Chinese adults [J]. Journal of Peking University (Health Sciences), 2023, 55(4): 606-611.
[7] Ling-fu ZHANG,Chun-sheng HOU,Zhi XU,Li-xin WANG,Xiao-feng LING,Gang WANG,Long CUI,Dian-rong XIU. Clinical effect of laparoscopic transcystic drainage combined with common bile duct exploration for the patients with difficult biliary stones [J]. Journal of Peking University (Health Sciences), 2022, 54(6): 1185-1189.
[8] Li-zhe AN,Liu-lin XIONG,Liang CHEN,Huan-rui WANG,Wei-nan CHEN,Xiao-bo HUANG. Laparoscopic pyeloplasty combined with ultrasonic lithotripsy via nephroscope for treatment of ureteropelvic junction obstruction with renal calculi [J]. Journal of Peking University (Health Sciences), 2022, 54(4): 746-750.
[9] Zhe HAO,Shu-hua YUE,Li-qun ZHOU. Application of Raman-based technologies in the detection of urological tumors [J]. Journal of Peking University (Health Sciences), 2022, 54(4): 779-784.
[10] Guang-qi LIU,Yuan-jie PANG,Jiang WU,Min LV,Meng-ke YU,Yu-tong LI,Yang-mu HUANG. Trend analysis of influenza vaccination among hospitalized elderly people in Beijing, 2013-2019 [J]. Journal of Peking University (Health Sciences), 2022, 54(3): 505-510.
[11] ZHANG Fan,CHEN Qu,HAO Yi-chang,YAN Ye,LIU Cheng,HUANG Yi,MA Lu-lin. Relationship between recovery of urinary continence after laparoscopic radical prostatectomy and preoperative/postoperative membranous urethral length [J]. Journal of Peking University (Health Sciences), 2022, 54(2): 299-303.
[12] LI Jia,XU Yu,WANG You-ya,GAO Zhan-cheng. Clinical characteristics of influenza pneumonia in the elderly and relationship between D-dimer and disease severity [J]. Journal of Peking University (Health Sciences), 2022, 54(1): 153-160.
[13] ZHANG Fan,HUANG Xiao-juan,YANG Bin,YAN Ye,LIU Cheng,ZHANG Shu-dong,HUANG Yi,MA Lu-lin. Relationship between prostate apex depth and early recovery of urinary continence after laparoscopic radical prostatectomy [J]. Journal of Peking University (Health Sciences), 2021, 53(4): 692-696.
[14] PENG Shun-zhuang, FU Xi-xi, FENG Xing-lin. Association between education and the onset of disability in activities of daily living in middle-aged and older Chinese adults: The mediator role of social participation [J]. Journal of Peking University (Health Sciences), 2021, 53(3): 549-554.
[15] Jia-li CHEN,Yue-bo JIN,Yi-fan WANG,Xiao-ying ZHANG,Jing LI,Hai-hong YAO,Jing HE,Chun LI. Clinical characteristics and risk factors of cardiovascular disease in patients with elderly-onset rheumatoid arthritis: A large cross-sectional clinical study [J]. Journal of Peking University (Health Sciences), 2020, 52(6): 1040-1047.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd