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Predictors of post-discharge pain and satisfaction with pain management after laparoscopic bariatric surgery: a prospective cohort study

  • 2023 SAGES Oral
  • Published:
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Abstract

Background

Pain management after bariatric surgery remains challenging given the risk for analgesia-related adverse events (e.g., opioid use disorder, marginal ulcers). Identifying modifiable factors associated with patient-reported pain outcomes may improve quality of care. We evaluated the extent to which patient and procedural factors predict 7-day post-discharge pain intensity, pain interference, and satisfaction with pain management after bariatric surgery.

Methods

This prospective cohort study included adults undergoing laparoscopic bariatric surgery at two university-affiliated hospitals and one private clinic. Preoperative assessments included demographics, Pain Catastrophizing Scale (score range 0–52), Patient Activation Measure (low [< 55.1] vs. high [≥ 55.1]), pain expectation (0–10), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) anxiety and depression scales. At 7 days post-discharge, assessments included PROMIS-29 pain intensity (0–10) and pain interference scales (41.6–75.6), and satisfaction with pain management (high [10–9] vs. lower [8–0]). Linear and logistic regression were used to assess the association of pain outcomes with potential predictors.

Results

Three hundred and fifty-one patients were included (mean age = 44 ± 11 years, BMI = 45 ± 8 kg/m2, 77% female, 71% sleeve gastrectomy). At 7 days post-discharge, median (IQR) patient-reported pain intensity was 2.5 (1–5), pain interference was 55.6 (52.0–61.2), and 76% of patients reported high satisfaction with pain management. Pain intensity was predicted by preoperative anxiety (β + 0.04 [95% CI + 0.01 to + 0.07]) and pain expectation (+ 0.15 [+ 0.05 to + 0.25]). Pain interference was predicted by preoperative anxiety (+ 0.22 [+ 0.11 to + 0.33]), pain expectation (+ 0.47 [+ 0.10 to + 0.84]), and age (− 0.09 [− 0.174 to − 0.003]). Lower satisfaction was predicted by low patient activation (OR 1.94 [1.05–3.58]), higher pain catastrophizing (1.03 [1.003–1.05]), 30-day complications (3.27 [1.14–9.38]), and age (0.97 [0.948–0.998]).

Conclusion

Patient-related factors are important predictors of post-discharge pain outcomes after bariatric surgery. Our findings highlight the value of addressing educational, psychological, and coping strategies to improve postoperative pain outcomes.

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Acknowledgements

The authors would also like to acknowledge the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) for their financial support in making this research possible.

Funding

This study was funded by a Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Grant awarded to Dr. Julio Fiore Jr., Dr. Amin Andalib, and Dr. Michel Gagner.

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Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada

    Maxime Lapointe-Gagner, Shrieda Jain, Hiba Elhaj, Pepa Kaneva, Mohsen Alhashemi, Lawrence Lee, Liane S. Feldman & Julio F. Fiore Jr.

  2. Division of Experimental Surgery, Department of Surgery, McGill University, Montreal, QC, Canada

    Maxime Lapointe-Gagner, Shrieda Jain, Naser Alali, Lawrence Lee, Liane S. Feldman & Julio F. Fiore Jr.

  3. Division of General Surgery, Department of Surgery, McGill University, Montreal, QC, Canada

    Naser Alali, Mohsen Alhashemi, Lawrence Lee, Liane S. Feldman, Amin Andalib & Julio F. Fiore Jr.

  4. Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada

    Hiba Elhaj & Anne-Sophie Poirier

  5. Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada

    Lawrence Lee, Ramanakumar V. Agnihotram, Liane S. Feldman & Julio F. Fiore Jr.

  6. Clinique Michel Gagner MD Inc., Montreal, QC, Canada

    Michel Gagner

  7. Department of Surgery, Center for Bariatric Surgery, McGill University, Montreal, QC, Canada

    Amin Andalib

  8. Montreal General Hospital, 1650 Cedar Ave, Montreal, QC, H3G 1A4, Canada

    Julio F. Fiore Jr.

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  1. Maxime Lapointe-Gagner
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  2. Shrieda Jain
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  3. Naser Alali
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  8. Lawrence Lee
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  9. Ramanakumar V. Agnihotram
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  10. Liane S. Feldman
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  11. Michel Gagner
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  12. Amin Andalib
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  13. Julio F. Fiore Jr.
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Corresponding author

Correspondence to Julio F. Fiore Jr..

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Disclosures

Julio F. Fiore Jr., Amin Andalib, and Michel Gagner received a research grant from the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) to conduct this study. Maxime Lapointe-Gagner, Shrieda Jain, Naser Alali, Hiba Elhaj, Anne-Sophie Poirier, Pepa Kaneva, Mohsen Alhashemi, Raman Agnihotram, Lawrence Lee, and Liane Feldman have no conflicts of interest or financial ties to disclose.

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Lapointe-Gagner, M., Jain, S., Alali, N. et al. Predictors of post-discharge pain and satisfaction with pain management after laparoscopic bariatric surgery: a prospective cohort study. Surg Endosc 37, 8611–8622 (2023). https://doi.org/10.1007/s00464-023-10307-3

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