Background & Aims

The incidence rates of moderate to severe pain post surgery have ranges widely between 30% and 80% depending on the definition of pain and the type of surgical procedure (1). In response, medical health and safety institutions in the Netherlands have mandated requirements for Dutch hospitals to enhance pain management protocols. Orthopaedic surgeries are often characterized by significant tissue trauma, such as bone cutting, joint n, and soft tissue dissection. The extent of tissue damage especially the periosteum and manipulation during these procedures can result in more substantial pain compared to other types of surgeries (2, 3, 4). This study aims to identify orthopaedic surgical procedures that induce severe pain in hospitalized patients within the first 72 hours after surgery.

Methods

We retrospectively analysed nurse-recorded pain scores from two general teaching hospitals and one academic hospital. The data included patients who received inpatient orthopaedic surgery between October 15, 2015, and December 31, 2019. In addition to patient and procedure characteristics, the highest numeric rating scale for pain was collected during three postoperative periods: 3 to 24 hours, 24 to 48 hours, and 48 to 72 hours. Surgical procedures were coded and stratified according to the International Classification of Health Interventions, subsequently ranked based on the highest median numerical rating scale for pain to identify procedures with the highest pain scores.

Results

A total of 9.918 cases were included in the analysis. The median highest pain score during 3 to 24 hours and 24 to 48 hours postoperative was 4 (IQR 3). The median highest pain score during 48 to 72 hours postoperative was 3 (IQR 2). Among the procedures with the highest pain scores during the three postoperative periods, open reduction and implantation of device into the humerus (e.g. plate fixation) is at the top of the ranking with a median numerical rating scale (NRS) for pain of 6 (IQR 3) in the period 3 to 48 hours postoperative and a median NRS of 5 (IQR 3) in the period 48 to 72 hours postoperative. Also, open procedures of the shoulder joint, open ankle procedures and open fusion of the lumbar spine were ranked in the top ten of procedures with high median pain scores.

Conclusions

In conclusion, this study offers valuable insights into pain experiences during the postoperative period among hospitalized orthopaedic patients from three Dutch hospitals. Our findings suggest that, open reduction of the humerus, open shoulder procedures, open ankle procedures, and lumbar spine procedures may not receive sufficient attention, emphasising the need for procedure-specific pain management approaches. Further analysis of the findings combining pain score data with analgesic medication data has the potential to enhance our comprehension of effective interventions in orthopaedic pain management.

References

1) Buvanendran A, Fiala J, Patel KA, Golden AD, Moric M, Kroin JS. The Incidence and Severity of Postoperative Pain following Inpatient Surgery. Pain Med. 2015;16(12):2277-83.

2) Ashoorion V, Sadeghirad B, Wang L, Noori A, Abdar M, Kim Y, et al. Predictors of Persistent Post-Surgical Pain Following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Observational Studies. Pain Med. 2023;24(4):369-81.

3) Williamson OD, Epi GD, Gabbe BJ, Physio B, Cameron PA, Edwards ER, et al. Predictors of moderate or severe pain 6 months after orthopaedic injury: a prospective cohort study. J Orthop Trauma. 2009;23(2):139-44.

4) Gerbershagen HJ, Aduckathil S, van Wijck AJ, Peelen LM, Kalkman CJ, Meissner W. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures. Anesthesiology. 2013;118(4):934-44.

Presenting Author

Bram Thiel

Poster Authors

Bram Thiel

MSc

OLVG

Lead Author

E-mail

Topics

  • Specific Pain Conditions/Pain in Specific Populations: Post-surgical/Post-traumatic Chronic Pain

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