Clinical Assistant Professor University of Calgary Calgary, Florida, United States
Introduction: Inadequate pain control after spine surgery is common and is associated with adverse outcomes. The impact of poor postoperative pain control on surgical outcomes has not been studied. Accordingly, the aim of this study was to investigate the relationship between poor postoperative pain control and surgical outcomes.
Methods: Consecutive adult patients (≥ 18-years old) undergoing elective cervical or thoracolumbar spine surgery were enrolled. Poor surgical outcome was defined as failure to achieve a minimally clinical important difference (MCID) of 30% improvement on the Oswestry Disability Index (ODI) or Neck Disability Index (NDI) at follow-up (3-months, 1-year, and 2-years). Poor pain control was defined as a mean numeric rating scale score of >4 during the first 24-hours after surgery. Univariable analyses followed by multivariable random-effects models were used to investigate the relationship between poor pain control and poor surgical outcome after adjusting for known risk factors that impact postoperative ODI and NDI. Age, sex, and follow-up time were forced into the multivariable model. Secondarily, the Calgary Postoperative Pain After Spine Surgery (CAPPS) score was investigated for its ability to predict poor surgical outcome.
Results: Overall, 42.8% of 1305 patients failed to achieve MCID at follow-up. The incidence of poor postoperative pain control after surgery was 56.9%. Multivariable analyses showed poor pain control after spine surgery was independently associated with failure to achieve MCID (OR 2.15 [95%CI=1.42-3.25], p< 0.001) after adjusting for age (p=0.15), sex (p=0.59), PHQ-9 depression score (p=0.030), ASA physical status >2 (p < 0.001), ≥3 motion segment surgery (p=0.003), revision surgery (p=0.032), and follow-up time (p < 0.001). Notably, daily use of preoperative opioid medications was not associated with failure to achieve MCID. The CAPPS score was also found to be an independent risk factor for poor surgical outcome (OR 1.15 [95%CI=1.014-3.31], p=0.03).
Conclusion : Poor pain control 24-hours after elective spine surgery was an independent risk factor for poor surgical outcome. Perioperative treatment strategies to improve postoperative pain control may lead to improved surgical outcomes.
