Genetic and Clinical Factors Associated with Chronic Postsurgical Pain after Hernia Repair, Hysterectomy, and Thoracotomy: A Two-year Multicenter Cohort Study
Antonio Montes, Gisela Roca, Sergi Sabate, Jose Ignacio Lao, Arcadi Navarro, Jordi Cantillo, Jaume Canet, GENDOLCAT Study Group, Consuelo Ruiz, Josep Delgado, Lissette del M Jimenez, Meritxell Sabria, Paloma Ricós, Antoni Perez, Carme Subira, Daniel Neira, Francisco Jose Anez, Gladys Margarita Hernndez, Isabel Cabre, Laura Silberman, Manuel Eduardo Lopez, María Garolera, Maria Teresa Guerrero, Marina García, Montserrat Yuste, Noemí Pou, Carmen Martín, Ester Lomban, Gisela Egido, José Antonio Bernia, Ricardo Leiro, Xavier Garcia, Jordi Troy, Antonia Bassols, Carme Colilles, Cristina Tremps, Diana Fernandez, Joan Blazquez, Josep Planell, Magdalena Serra, Marti Sola, Mercedes Rosas, Montserrat Canellas, Victor Espiga, Fernando Martinez, Maria Teresa Vilalta, Ana Bogdanovich, Teresa Anglada, Anna Vidal, Josep Canudas, Ana Peiro, Luis Gómez, Yolanda Sastre, Vicente Domingo, Antonio Antolí, Belén Bardisa, Gerardo Presencia, Julian García, Teresa Crespo, Ramon Jose Ferri, Vicente Rosello, Dolors Sintes, Ana Sape, Candi Giralt, Eduardo Esteva, Elena Barcelo, Fernando Rey, Joan Fornaguera, Luis Martinez, Montserrat Pijoan, Raquel Mansilla, Jose Luis Casbas, Antonio Monso, Inma Garrido, Joaquin Torres, Laura Mahillo, Gregorio Marco, Dolors Del Pozo, Montserrat Torra, Reis Drudis, Ancor Serrano, Antoni Sabate, Carmen Ribes, Eugenia Martínez, María Valcárcel, Resurrección Sanzol, Víctor Mayoral, Josep Vilaplana, Antonio Villalonga, Antoni Arxer, Joaquim Pujol, Elena Catala, Ana Bueno, Bartomeu Cantallops, Angeles Gil de Bernabé, Carmen Unzueta, Teresa Rivilla, Marc Bausili, Miren Revuelta, Gisela Roca, Agnes Marti, Alicia Melero, Anna Flo, Daniel Samper, Jaume Canet, Jordi Busquets, Josefina Bassons, Mar Monerris, Marta Hinojosa, Pere Vila, Rosa Rincón, Roser Garcia, Jose Maria Loro, Aitana Lluch, Ana Tur, Antonio Abengochea, Juan Gallego, Manuel Barbera, Maria Soledad Pelaez, Domingo Jorge Echevarria, Pilar Prieto, Dolors Pérez, Ildefons Sard, Jesús Cuenca, Victòria Ribera, Angela Mesas, Anna González, Carme Bosch, Conxita Munoz, Cristina Aguilera, Daniel Ruiz, Dolors Mateo, Gloria Agreda, Imma Vives, Jaume Roige, Dolores Dorda, Patricia Bascunana, Patricia Ciurana, Pilar Cortiella, Susana Manrique, Dolors Pelegrí, Anna Abad, Anna Faura, Domingo Blanco, Elisenda Izquierdo, Carmen López, José Linares, Paco Nebot, Robert Rodríguez, Santiago Beltrán, Benet Casagran, Claudia Liliana Charry, Olga Pineda, Susana Fernández, Alejandro Perez, Amelia Rojo, Antonio Montes, Carlos Alberto García, Fernando Escolano, Luis Molto, Nuria Baldomá, Raquel Arroyo, Ricardo Lopez, Saida Sanchez, Ana Bogdanovich, Jaume Canet, Elena Catala, Jose Ignacio Lao, Victor Mayoral, Antonio Montes, Dolors Pelegrí, Victòria Ribera, Gisela Roca, Sergi Sabate, Jordi Troy, Jordi Cantillo, Carlos Morcillo, Arcadi Navarro, Jose Ignacio Lao, Carlos Morcillo, Arcadi Navarro, Gemma Vilagut, Antonio Montes, Gisela Roca, Sergi Sabate, Jose Ignacio Lao, Arcadi Navarro, Jordi Cantillo, Jaume Canet, GENDOLCAT Study Group, Consuelo Ruiz, Josep Delgado, Lissette del M Jimenez, Meritxell Sabria, Paloma Ricós, Antoni Perez, Carme Subira, Daniel Neira, Francisco Jose Anez, Gladys Margarita Hernndez, Isabel Cabre, Laura Silberman, Manuel Eduardo Lopez, María Garolera, Maria Teresa Guerrero, Marina García, Montserrat Yuste, Noemí Pou, Carmen Martín, Ester Lomban, Gisela Egido, José Antonio Bernia, Ricardo Leiro, Xavier Garcia, Jordi Troy, Antonia Bassols, Carme Colilles, Cristina Tremps, Diana Fernandez, Joan Blazquez, Josep Planell, Magdalena Serra, Marti Sola, Mercedes Rosas, Montserrat Canellas, Victor Espiga, Fernando Martinez, Maria Teresa Vilalta, Ana Bogdanovich, Teresa Anglada, Anna Vidal, Josep Canudas, Ana Peiro, Luis Gómez, Yolanda Sastre, Vicente Domingo, Antonio Antolí, Belén Bardisa, Gerardo Presencia, Julian García, Teresa Crespo, Ramon Jose Ferri, Vicente Rosello, Dolors Sintes, Ana Sape, Candi Giralt, Eduardo Esteva, Elena Barcelo, Fernando Rey, Joan Fornaguera, Luis Martinez, Montserrat Pijoan, Raquel Mansilla, Jose Luis Casbas, Antonio Monso, Inma Garrido, Joaquin Torres, Laura Mahillo, Gregorio Marco, Dolors Del Pozo, Montserrat Torra, Reis Drudis, Ancor Serrano, Antoni Sabate, Carmen Ribes, Eugenia Martínez, María Valcárcel, Resurrección Sanzol, Víctor Mayoral, Josep Vilaplana, Antonio Villalonga, Antoni Arxer, Joaquim Pujol, Elena Catala, Ana Bueno, Bartomeu Cantallops, Angeles Gil de Bernabé, Carmen Unzueta, Teresa Rivilla, Marc Bausili, Miren Revuelta, Gisela Roca, Agnes Marti, Alicia Melero, Anna Flo, Daniel Samper, Jaume Canet, Jordi Busquets, Josefina Bassons, Mar Monerris, Marta Hinojosa, Pere Vila, Rosa Rincón, Roser Garcia, Jose Maria Loro, Aitana Lluch, Ana Tur, Antonio Abengochea, Juan Gallego, Manuel Barbera, Maria Soledad Pelaez, Domingo Jorge Echevarria, Pilar Prieto, Dolors Pérez, Ildefons Sard, Jesús Cuenca, Victòria Ribera, Angela Mesas, Anna González, Carme Bosch, Conxita Munoz, Cristina Aguilera, Daniel Ruiz, Dolors Mateo, Gloria Agreda, Imma Vives, Jaume Roige, Dolores Dorda, Patricia Bascunana, Patricia Ciurana, Pilar Cortiella, Susana Manrique, Dolors Pelegrí, Anna Abad, Anna Faura, Domingo Blanco, Elisenda Izquierdo, Carmen López, José Linares, Paco Nebot, Robert Rodríguez, Santiago Beltrán, Benet Casagran, Claudia Liliana Charry, Olga Pineda, Susana Fernández, Alejandro Perez, Amelia Rojo, Antonio Montes, Carlos Alberto García, Fernando Escolano, Luis Molto, Nuria Baldomá, Raquel Arroyo, Ricardo Lopez, Saida Sanchez, Ana Bogdanovich, Jaume Canet, Elena Catala, Jose Ignacio Lao, Victor Mayoral, Antonio Montes, Dolors Pelegrí, Victòria Ribera, Gisela Roca, Sergi Sabate, Jordi Troy, Jordi Cantillo, Carlos Morcillo, Arcadi Navarro, Jose Ignacio Lao, Carlos Morcillo, Arcadi Navarro, Gemma Vilagut
Abstract
Background: Chronic postsurgical pain (CPSP) has been linked to many surgical settings. The authors aimed to analyze functional genetic polymorphisms and clinical factors that might identify CPSP risk after inguinal hernia repair, hysterectomy, and thoracotomy.
Methods: This prospective multicenter cohort study enrolled 2,929 patients scheduled for inguinal hernia repair, hysterectomy (vaginal or abdominal), or thoracotomy. The main outcome was the incidence of CPSP confirmed by physical examination 4 months after surgery. The secondary outcome was CPSP incidences at 12 and 24 months. The authors also tested the associations between CPSP and 90 genetic markers plus a series of clinical factors and built a CPSP risk model.
Results: Within a median of 4.4 months, CPSP had developed in 527 patients (18.0%), in 13.6% after hernia repair, 11.8% after vaginal hysterectomy, 25.1% after abdominal hysterectomy, and 37.6% after thoracotomy. CPSP persisted after a median of 14.6 months and 26.3 months in 6.2% and 4.1%, respectively, after hernia repair, 4.1% and 2.2% after vaginal hysterectomy, 9.9% and 6.7% after abdominal hysterectomy, and 19.1% and 13.2% after thoracotomy. No significant genetic differences between cases and controls were identified. The risk model included six clinical predictors: (1) surgical procedure, (2) age, (3) physical health (Short Form Health Survey-12), (4) mental health (Short Form Health Survey-12), (5) preoperative pain in the surgical field, and (6) preoperative pain in another area. Discrimination was moderate (c-statistic, 0.731; 95% CI, 0.705 to 0.755).
Conclusions: Until unequivocal genetic predictors of CPSP are understood, the authors encourage systematic use of clinical factors for predicting and managing CPSP risk.
Trial registration: ClinicalTrials.gov NCT01510496.
Source: PubMed