Background

The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting.

Methods

This study assessed pain 90 days after ambulatory surgery in an international, multicenter prospective cohort study of patients at least 45 yr old with comorbidities or at least 65 yr old. Pain was assessed using the Brief Pain Inventory. Chronic postsurgical pain was defined as a change of more than 1 point in self-rated average pain at the surgical site between baseline and 90 days, and moderate to severe chronic postsurgical pain was defined as a score greater than 4 in self-rated average pain at the surgical site at 90 days. Risk factors for chronic postsurgical pain were identified using multivariable logistic regression.

Results

Between November 2021 and January 2023, a total of 2,054 participants were included, and chronic postsurgical pain occurred in 12% of participants, of whom 93.1% had new chronic pain at the surgical site (i.e., participants without pain before surgery). Moderate to severe chronic postsurgical pain occurred in 9% of overall participants. Factors associated with chronic postsurgical pain were active smoking (odds ratio, 1.82; 95% CI, 1.20 to 2.76), orthopedic surgery (odds ratio, 4.7; 95% CI, 2.24 to 9.7), plastic surgery (odds ratio, 4.3; 95% CI, 1.97 to 9.2), breast surgery (odds ratio, 2.74; 95% CI, 1.29 to 5.8), vascular surgery (odds ratio, 2.71; 95% CI, 1.09 to 6.7), and ethnicity (i.e., for Hispanic/Latino ethnicity, odds ratio, 3.41; 95% CI, 1.68 to 6.9 and for First Nations/native persons, odds ratio, 4.0; 95% CI, 1.05 to 15.4).

Conclusions

Persistent postsurgical pain after same-day surgery is common, is usually moderate to severe in nature, and occurs mostly in patients without chronic pain before surgery.

Editor’s Perspective
What We Already Know about This Topic
  • Chronic postsurgical pain, defined as pain persisting more than 3 months after surgical injury, may occur after a variety of procedures, with greater surgical extent and individual patient-level biopsychosocial characteristics conferring greater risk
  • Same-day surgery has markedly increased in recent decades, potentially jeopardizing the ability to identify individuals who will struggle with managing their postsurgical pain, thus raising the stakes for accurate preoperative prediction
What This Article Tells Us That Is New
  • This international, multicenter, prospective, longitudinal cohort study of more than 2,000 patients undergoing a variety of outpatient surgical procedures revealed that 9% of patients reported moderate to severe surgical area pain at 3 months after surgery
  • Factors that were independently associated with higher odds of chronic postsurgical pain in this cohort were preoperative pain, Hispanic or First Nations ethnicity, active smoking, and certain surgical types including orthopedic, plastic, breast, or vascular surgery