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International Orthopaedics

, Volume 36, Issue 11, pp 2261–2267 | Cite as

Predictors for moderate to severe acute postoperative pain after total hip and knee replacement

  • Spencer S. LiuEmail author
  • Asokumar Buvanendran
  • James P. Rathmell
  • Mona Sawhney
  • James J. Bae
  • Mario Moric
  • Stephen Perros
  • Ashley J. Pope
  • Lazaros Poultsides
  • Craig J. Della Valle
  • Naomi S. Shin
  • Colin J. L. McCartney
  • Yan Ma
  • Mahendrakumar Shah
  • Monica J. Wood
  • Smith C. Manion
  • Thomas P. Sculco
Original Paper

Abstract

Purpose

The ability to identify and focus care to patients at higher risk of moderate to severe postoperative pain should improve analgesia and patient satisfaction, and may affect reimbursement. We undertook this multi-centre cross-sectional study to identify preoperative risk factors for moderate to severe pain after total hip (THR) and knee (TKR) replacement.

Methods

A total of 897 patients were identified from electronic medical records. Preoperative information and anaesthetic technique was gained by retrospective chart review. The primary outcomes were moderate to severe pain (pain score ≥ 4/10) at rest and with activity on postoperative day one. Logistic regression was performed to identify predictors for moderate to severe pain.

Results

Moderate to severe pain was reported by 20 % at rest and 33 % with activity. Predictors for pain at rest were female gender (OR 1.10 with 95 % CI 1.01–1.20), younger age (0.96, 0.94–0.99), increased BMI (1.02, 1.01–1.03), TKR vs. THR (3.21, 2.73–3.78), increased severity of preoperative pain at the surgical site (1.15, 1.03–1.30), preoperative use of opioids (1.63, 1.32–2.01), and general anaesthesia (8.51, 2.13–33.98). Predictors for pain with activity were TKR vs. THR (1.42, 1.28–1.57), increased severity of preoperative pain at the surgical site (1.11, 1.04–1.19), general anaesthesia (9.02, 3.68–22.07), preoperative use of anti-convulsants (1.78, 1.32–2.40) and anti-depressants (1.50, 1.08–2.80), and prior surgery at the surgical site (1.28, 1.05–1.57).

Conclusions

Our findings provide clinical guidance for preoperative stratification of patients for more intensive management potentially including education, nursing staffing, and referral to specialised pain management.

Keywords

Total Knee Replacement Generalise Estimate Equation Preoperative Pain Improve Patient Satisfaction Acute Postoperative Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgment

Funding was provided by the Department of Anesthesiology, Hospital for Special Surgery. Dr. Ma was partially supported by Clinical Translational Science Center (NIH UL1-RR024996). Dr. Della Valle is a consultant for Biomet, Convatec and Smith & Nephew and receives research support from Smith & Nephew and Zimmer. Dr. Sculco receives research support from Exactech.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Spencer S. Liu
    • 1
    Email author
  • Asokumar Buvanendran
    • 4
  • James P. Rathmell
    • 6
  • Mona Sawhney
    • 7
  • James J. Bae
    • 1
  • Mario Moric
    • 4
  • Stephen Perros
    • 6
  • Ashley J. Pope
    • 7
  • Lazaros Poultsides
    • 2
  • Craig J. Della Valle
    • 5
  • Naomi S. Shin
    • 6
  • Colin J. L. McCartney
    • 7
  • Yan Ma
    • 3
  • Mahendrakumar Shah
    • 4
  • Monica J. Wood
    • 6
  • Smith C. Manion
    • 6
  • Thomas P. Sculco
    • 2
  1. 1.Department of AnesthesiologyHospital for Special Surgery and Weill Cornell Medical CollegeNew YorkUSA
  2. 2.Department of Orthopedic SurgeryHospital for Special Surgery and Weill Cornell Medical CollegeNew YorkUSA
  3. 3.Department of Public HealthWeill Cornell Medical CollegeNew YorkUSA
  4. 4.Department of AnesthesiologyRush University Medical Center and Rush Medical CollegeChicagoUSA
  5. 5.Department of Orthopedic SurgeryRush University Medical Center and Rush Medical CollegeChicagoUSA
  6. 6.Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  7. 7.Department of AnesthesiaSunnybrook Health Sciences Centre and University of TorontoTorontoCanada

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