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Chronic pain following elective surgery under general anesthesia in older adults

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Abstract

Background

The purpose of this study was to investigate the association between age and chronic postsurgical pain (CPSP) in patients who underwent elective surgery under general anesthesia, with a focus on long-term postsurgical analgesic use. To our knowledge, no previous study has examined this relationship in detail between older and younger patients.

Methods

We conducted a propensity score-matched (PSM) study to compare the rates of long-term (3 or 6 months) postoperative analgesic use between older adult (≥ 65 years) and younger (< 65 years) patients. Multivariate logistic regression was used to assess the use of analgesics as a surrogate indicator of CPSP.

Results

The PSM analysis included 62,784 surgical patients (31,392 in each group). Three months after surgery, the rates of analgesic use were significantly higher in the older age group (adjusted odds ratio [aOR], 1.45; 95% confidence interval [CI], 1.41–1.49) as well as for opioid use specifically (aOR, 1.34; 95% CI, 1.29–1.39). Six months after surgery, the rates of analgesic use remained higher in the older age group (aOR, 1.52; 95% CI, 1.47–1.58), and similarly for opioid use specifically (aOR, 1.42; 95% CI, 1.36–1.48).

Conclusions

Our findings suggest that older adults have higher rates of long-term analgesic use for CPSP after elective surgery under general anesthesia. This study highlights the importance of addressing CPSP in older adult patients and considering age-related factors when managing postoperative pain.

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Availability of data and material

The datasets supporting the study conclusions are included within this manuscript and its additional files.

Abbreviations

OR:

Odds ratio

aOR:

Adjusted odds ratio

CI:

Confidence interval

ICD-9-CM:

International classification of diseases, ninth revision, clinical modification

ICD-10-CM:

International classification of diseases, tenth revision, clinical modification

PSM:

Propensity score matching

NHIRD:

National Health Insurance Research Database

ASA:

American Society of Anesthesiology

SD:

Standard deviation

SMD:

Standardized mean difference

IQR:

Interquartile range

y:

Years

SMI:

Skeletal muscle mass index

CCI:

Charlson comorbidity index

ORIF:

Open reduction internal fixation

AIDS:

Acquired immunodeficiency syndrome

aDCSI:

Adapted Diabetes Complications Severity Index

ARD:

Alcohol-related disease

CPSP:

Chronic postsurgical pain

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Funding

Lo-Hsu Medical Foundation, LotungPoh-Ai Hospital, supports Szu-Yuan Wu’s work (Funding Number: 11001, 11010, 11013 and 11103).

Author information

Author notes

  1. Mingyang Sun and Wan-Ming Chen have contributed equally to this study (joint primary authors).

  2. Szu-Yuan Wu and Jiaqiang Zhang have contributed equally to this study (joint Correspondence authors).

Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, Zhengzhou, Henan, China

    Mingyang Sun & Jiaqiang Zhang

  2. Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan

    Wan-Ming Chen & Szu-Yuan Wu

  3. Artificial Intelligence Development Center, Fu Jen Catholic University, Taipei, Taiwan

    Wan-Ming Chen & Szu-Yuan Wu

  4. Department of Food Nutrition and Health Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan

    Szu-Yuan Wu

  5. Big Data Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan

    Szu-Yuan Wu

  6. Division of Radiation Oncology, Department of Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan

    Szu-Yuan Wu

  7. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan

    Szu-Yuan Wu

  8. Cancer Center, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, No. 83, Nanchang St., Luodong Township, Yilan County 265, Taiwan

    Szu-Yuan Wu

  9. Centers for Regional Anesthesia and Pain Medicine, Taipei Municipal Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Szu-Yuan Wu

  10. Department of Management, College of Management, Fo Guang University, Yilan, Taiwan

    Szu-Yuan Wu

Authors
  1. Mingyang Sun
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  2. Wan-Ming Chen
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  4. Jiaqiang Zhang
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Contributions

Conception and design: MS; W-MC; S-YW; JZ. Financial support: L–H: Medical Foundation, LotungPoh-Ai Hospital, supports S-YW: work (Funding Number: 11001, 11,010, 11,013 and 11,103). Collection and assembly of data: MS; S-YW; JZ. Data analysis and interpretation: JZ; S-YW. Administrative support: S-YW*. Manuscript writing: MS; W-MC; S-YW; JZ. Final approval of manuscript: all authors.

Corresponding authors

Correspondence to Szu-Yuan Wu or Jiaqiang Zhang.

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Conflict of interest

All authors have no conflicts of interest.

Ethical approval and consent

The study protocols were reviewed and approved by the Institutional Review Board of Tzu-Chi Medical Foundation (IRB109-015-B).

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Cite this article

Sun, M., Chen, WM., Wu, SY. et al. Chronic pain following elective surgery under general anesthesia in older adults. J Anesth 37, 604–615 (2023). https://doi.org/10.1007/s00540-023-03215-2

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