Postoperative Pain and Age: A Retrospective Cohort Association Study

Abstract

Background As the population ages, the number of elderly people undergoing surgery increases. Literature on the incidence and intensity of postoperative pain in the elderly is conflicting. This study examines associations between age and pain-related patient reported outcomes and perioperative pain management in a dataset of surgical patients undergoing four common surgeries: spinal surgery, hip or knee replacement, or laparoscopic cholecystectomy. Based on the authors’ clinical experience, they hypothesize that pain scores are lower in older patients. Methods In this retrospective cohort, study data were collected between 2010 and 2018 as part of the international PAIN OUT program. Patients filled out the International Pain Outcomes Questionnaire on postoperative day 1. Results A total of 11,510 patients from 26 countries, 59% female, with a mean age of 62 yr, underwent one of the aforementioned types of surgery. Large variation was detected within each age group for worst pain, yet for each surgical procedure, mean scores decreased significantly with age (mean Numeric Rating Scale range, 6.3 to 7.3; β = –0.2 per decade; P ≤ 0.001), representing a decrease of 1.3 Numeric Rating Scale points across a lifespan. The interference of pain with activities in bed, sleep, breathing deeply or coughing, nausea, drowsiness, anxiety, helplessness, opioid administration on the ward, and wish for more pain treatment also decreases with age for two or more of the procedures. Across the procedures, patients reported being in severe pain on postoperative day one 26 to 38% of the time, and pain interfered moderately to severely with movement. Conclusions The authors’ findings indicate that postoperative pain decreases with increasing age. The change is, however, small and of questionable clinical significance. Additionally, there are still too many patients, at any age, undergoing common surgeries who suffer from moderate to severe pain, which interferes with function, supporting the need for tailoring care to the individual patient. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Early Postoperative Pain Trajectories after Posterolateral and Axillary Approaches to Thoracic Surgery: A Prospective Monocentric Observational Study

“…We did not find an association between female gender and increased postoperative pain intensity, as previously shown across a variety of surgical procedures [ 20 , 23 , 24 ], but as we have seen above, other studies did not find this factor [ 19 ]. Similarly, we did not find that young age is linked to increased postoperative pain, as previously reported [ 10 , 19 , 20 , 22 ], although van Dijk et al reported in a large and heterogenous international cohort that postoperative pain decreases with increasing age, but these authors qualified this relation as small and of questionable clinical significance [ 25 ].…”

Development and validation of a multivariable prediction model for early prediction of chronic postsurgical pain in adults: a prospective cohort study

“…This may be explained by the wide range of surgical procedures included in this study, with varying sex and age distributions per surgery type, diluting possible effects of age and sex on CPSP development as was seen in previous work. 39 This study has strengths and limitations. Strengths include the prospective population-based design, the relatively large sample size, the use of high-quality data, and adherence to the TRIPOD statement's recommendations.…”

Evaluation of preoperative duloxetine use for postoperative analgesia following laparoscopic cholecystectomy: A randomized controlled trial

“…It evaluated short-term outcomes of preemptive analgesia with duloxetine; however, long-term outcomes such as rates of developing chronic post-surgical pain are also important and need to be evaluated. In addition, the severity of post-surgical pain might be confounded by some preoperative patient-related factors such as age, anxiety level before surgery, or gender ( Hussain et al, 2013 ; Pereira and Pogatzki-Zahn 2015 ; Thomazeau et al, 2016 ; Zorrilla-Vaca et al, 2019 ; van Dijk et al, 2021 ). The small sample size and the simple randomization employed in the current study hindered our ability to examine how these confounders might potentially impact the study outcomes.…”

“…Frontiers in Pharmacology frontiersin.org such as age, anxiety level before surgery, or gender (Hussain et al, 2013;Pereira and Pogatzki-Zahn 2015;Thomazeau et al, 2016;Zorrilla-Vaca et al, 2019;van Dijk et al, 2021). The small sample size and the simple randomization employed in the current study hindered our ability to examine how these confounders might potentially impact the study outcomes.…”