Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – A retrospective cohort study

Cohen, Barak; Tanios, Marianne; Koyuncu, Onur; Yılmaz, Hüseyin Oğuz; Raza, Syed; Mukhdomi, Junaid; Artis, Amanda; Seif, John; Chhabada, Surendrasingh; Turan, Alparslan

doi:10.1016/j.jclinane.2020.109729

Cited by 14 publications

(8 citation statements)

References 14 publications

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“…In our cohort, the higher the BMI, the higher the postoperative pain. Contrary to Cohen, who proposed that BMI was not associated with postoperative pain [43], our ndings are consistent with van Helmond, who concluded that BMI may be a risk factor for persistent postoperative pain [44]. We agree with Hartwig, that younger age is associated with severe postoperative pain during the rst 24 hours [45].…”

Section: Discussionsupporting

confidence: 88%

Analgesics around the clock is better than the on-demand modality for pain treatment after hemorrhoid surgery

Susmallian

Aviv

Babis

et al. 2022

Preprint

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Background: This study aims to investigate the best pharmacological treatment for postoperative pain after hemorrhoidectomy. Material and Methods: This prospective non-randomized study included 5335 patients who underwent hemorrhoidectomy from July 2016 to December 2020, divided into two groups: "around-the-clock" analgesic treatment (ACAT) with 3,767 participants, and "on-demand" analgesic treatment (ODAT) with 1568 participants. Results: The mean age was 47.47 years old, 59.98% male. Postoperatively, severe pain was reported by 14.13% of the patients, moderate pain in 36.49%, mild pain in 34.28%, and no pain in 15.09%. In the ACAT group, the mean for maximum pain was 3.04 on the Visual Analogue Scale (VAS) and 4.95 for the ODAT group. The average pain in the ACAT group was 0.79 VAS and for the ODAT group 1.45 VAS. The pain at the time of discharge was 0.42 (SD±0.730) VAS for the ACAT group and 0.63 (SD±0.799) VAS for the ODAT group. Comparing the three modalities of pain measurement, the ACAT group reported significantly less pain (p<.001). Having a higher BMI and being younger were risk factors for pain (p=.049, and p<.001, respectively). The ACAT group used significantly fewer opioids, which decreased the use of meperidine by 68.38% less; morphine by 43.57%, tramadol by 46.82%; 38.74% oxycodone; and codeine by 53.40% less. The need for non-opioid analgesics was also lower in the ACAT group, between 16-59% less than in the ODAT group. Conclusion: Hemorrhoidectomy induces moderate postoperative pain and only 14% of the patients suffer severe pain. A fixed schedule multimodal pain regime diminishes pain from moderate to mild after hemorrhoidectomy, independent of procedure and anesthesia type, thereby reducing the doses of opioids needed from between 38 to 68%, and reducing the dosage of non-opiates as well. Higher BMI and youngest age were recognized as risk factors for higher postoperative pain. Trial registration clinicaltrials.gov (NCT04953182). Available at: https://clinicaltrials.gov/ct2/show/NCT04953182

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Section: Discussionsupporting

confidence: 88%

Analgesics around the clock is better than the on-demand modality for pain treatment after hemorrhoid surgery

Susmallian

Aviv

Babis

et al. 2022

Preprint

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“…Finally, we also found some evidence of lower ROU in higher BMI patients (Fig. 3A), a finding we do not believe has been explicitly reported in the colorectal literature but has been described in other surgical fields, including pediatric surgery 29 . This may be related to overall decreased abdominal muscle mass—which is a major source of pain from port placement—or a sequela of sensory dysfunction and increased pain detection thresholds in the obese population 30 …”

Section: Discussionsupporting

confidence: 57%

“…3A), a finding we do not believe has been explicitly reported in the colorectal literature but has been described in other surgical fields, including pediatric surgery. 29 This may be related to overall decreased abdominal muscle mass-which is a major source of pain from port placement-or a sequela of sensory dysfunction and increased pain detection thresholds in the obese population. 30 In addition to treating ROU as an outcome variable in and of itself, we also sought to correlate it with other outcomes.…”

Section: Discussionmentioning

confidence: 99%

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Vu,

Franko,

Buzadzhi

et al. 2024

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: The ongoing opioid crisis demands an investigation into the factors driving postoperative opioid use. Ambulatory robotic colectomies are an emerging concept in colorectal surgery, but concerns persist surrounding adequate pain control for these patients who are discharged very early. We sought to identify key factors affecting recovery room opioid use (ROU) and additional outpatient opioid prescriptions (AOP) after ambulatory robotic colectomies. Methods: This was a single-institution retrospective review of ambulatory robotic colon resections performed between 2019 and 2022. Patients were included if they discharged on the same day (SDD) or postoperative day 1 (POD1). Outcomes of interest included ROU [measured in parenteral morphine milligram equivalents (MMEs)], AOP (written between PODs 2 to 7), postoperative emergency department presentations, and readmissions. Results: Two hundred nineteen cases were examined, 48 of which underwent SDD. The mean ROU was 29.4 MME, and 8.7% of patients required AOP. Between SDD and POD1 patients, there were no differences in postoperative emergency department presentations, readmissions, recovery opioid use, or additional outpatient opioid scripts. Older age was associated with a lower ROU (−0.54 MME for each additional year). Older age, a higher body mass index, and right-sided colectomies were also more likely to use zero ROU. Readmissions were strongly associated with lower ROU. Among SDD patients, lower ROU was also associated with higher rates of AOP. Conclusion: Ambulatory robotic colectomies and SDD can be performed with low opioid use and readmission rates. Notably, we found an association between low ROU and more readmission, and, in some cases, higher AOP. This suggests that adequate pain control during the postoperative recovery phase is a crucial component of reducing these negative outcomes.

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“…Age, sex, and BMI are controversial risk factors for CPSP. Younger age, female sex, and higher BMI are usually considered to be associated with an increased risk of developing CPSP ( 4 , 45 – 48 ), but some studies have reached different conclusions ( 10 , 49 – 51 ). However, female sex and higher BMI were not independent risk factors for CPSP, and CPSP was more apparent in older age in this study.…”

Section: Discussionmentioning

confidence: 99%

Change in perioperative neutrophil-lymphocyte ratio as a potential predictive biomarker for chronic postsurgical pain and quality of life: an ambispective observational cohort study

et al. 2023

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IntroductionAccurate and accessible predictors of chronic postsurgical pain (CPSP) to identify high-risk postsurgical patients are prerequisite for preventive and interventional strategies. We investigated the incidence and risk factors of CPSP after abdominal surgery, with a focus on plasma immunological markers.Materials and methodsThis was a retrospective analysis of patients who underwent abdominal surgery under general anesthesia at a tertiary center between January 2021 and January 2022. The preoperative demographics, laboratory test data, and surgical factors of the participants were collected from the electronic medical record system. Postoperative pain intensity and living conditions at 1 year after discharge from the hospital were assessed via a phone survey. Univariate and multivariate analyses were used to explore independent risk factors associated with CPSP.ResultsA total of 968 patients were included, and 13.53% (n = 131 of 968) of patients reported CPSP 1 year after surgery. Patients with older age, open surgery, higher American Association of Anesthesiologists classification, patient-controlled intravenous analgesia application, longer surgery duration, higher postoperative absolute neutrophil count, and neutrophil-lymphocyte ratio (NLR), lower postoperative absolute lymphocyte count, and higher white blood cell count, were more likely to suffer from CPSP. A changed ratio of NLR (postoperative to preoperative) ≥ 5 significantly correlated with CPSP, moderate to severe pain, maximum numeric rating score since discharge from the hospital, and affected quality of life.DiscussionThe changed ratio of NLR could be used for the early identification of patients at risk for CPSP and affect the quality of life to alert the clinician to undertake further assessment.

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Association between higher BMI and postoperative pain and opioid consumption in pediatric inpatients – A retrospective cohort study

Cited by 14 publications

References 14 publications

Analgesics around the clock is better than the on-demand modality for pain treatment after hemorrhoid surgery

Analgesics around the clock is better than the on-demand modality for pain treatment after hemorrhoid surgery

Ambulatory Robotic Colectomy: Factors Affecting and Affected by Postoperative Opioid Use

Change in perioperative neutrophil-lymphocyte ratio as a potential predictive biomarker for chronic postsurgical pain and quality of life: an ambispective observational cohort study

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