BACKGROUND Our aim was to describe the long-term prevalence, risk factors and impact on quality of life of Persistent Postsurgical Pain (PPP) following cardiac surgery.
METHODS All patients undergoing sternotomy in a single centre over a six-month period were prospectively interviewed by telephone at six months and seven years following surgery.
RESULTS We analysed data from 174 patients at six months and 146 patients at seven years following surgery revealing a PPP prevalence of 39.7% (n = 69) and 9.6% (n = 14) respectively. At six postoperative months, younger age, higher acute pain score, intraoperative remifentanil infusion and more prolonged surgery were associated with sternotomy-site PPP. These variables, in combination, predict PPP in this study group with Area under the Receiver Operating Curve of 0.91 (95% CI 0.86-0.94) at six months and 0.74 (95% CI 0.57-0.86) at seven years. Quality of life scores were significantly lower with PPP (Median change in EQ-5D score = -0.23 [-0.57, -0.09] compared to 0.00 [0-0.24]without PPP at seven years, p<0.001). At seven years, younger age, prolonged surgery and intraoperative remifentanil infusion were associated with sternotomy-site PPP.
CONCLUSION To the best of our knowledge, this is the longest follow up of PPP across all surgical specialities and certainly within cardiac surgery. Prevalence of PPP and impact on QOL after cardiac surgery are high and associated with young age, high acute pain score, use of remifentanil and long operative time. We present a predictive score to highlight patients at risk of developing PPP.