Zhao, Jian
(2023)
Identifying Distinct Trajectories of Acute Post-Surgical Pain and Their Associations with Persistent Post-Surgical Pain, Opioid Use, and 30-Day Readmission After Abdominal Hysterectomy for Gynecologic Cancer.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Background: Acute post-surgical pain (APSP) following hysterectomy is a critical concern, especially in the context of gynecologic cancer. APSP often extends hospital stays and increases medical costs and may evolve into chronic pain if not adequately managed. Despite its dynamic nature, APSP is frequently operationalized as a static variable, leading to a gap in research regarding its trajectories and long-term implications post-hysterectomy.
Purpose: (1) determine distinct APSP trajectories over five days post-hysterectomy in gynecologic cancer patients; (2) analyze factors associated with these pain trajectories; and (3) explore the associations between APSP trajectories and postoperative outcomes, including 30-day readmission, persistent postsurgical pain, and prolonged opioid usage, with a particular focus on high-risk gynecologic cancer cases.
Methods: Utilizing a large Enhanced Recovery After Surgery (ERAS) dataset and medical records, the study examined adult patients undergoing abdominal hysterectomy from 2019 to 2021. It included 1342 gynecologic cancer patients, with 407 having high-risk cancers and receiving chemotherapy. Group-based trajectory modeling identified APSP patterns, and multinomial regression analyzed associated factors. High-risk endometrial and ovarian cancer patients were separately studied to link APSP trajectories to postoperative outcomes.
Results: Four APSP trajectories were found: no pain, rapid resolution, slow resolution, and ongoing pain. Factors like prior anxiety, preoperative pelvic pain, open hysterectomy, and higher ASA Class increased ongoing pain likelihood. Higher CCI scores and longer surgeries correlated with less chance of no or rapid pain resolution. In high-risk patients, three trajectories were noted. Ongoing pain trajectory was a significant predictor for persistent post-hysterectomy pain and 30-day readmission.
Conclusions This investigation illuminates the incidence of ongoing APSP in gynecologic cancer patients. The distinct pain trajectories identified are instrumental for tailoring postoperative pain management. Recognizing these patterns is pivotal for healthcare providers to deploy targeted interventions that mitigate chronic pain and reduce opioid dependency, optimizing recovery after hysterectomy.
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Details
| Item Type: |
University of Pittsburgh ETD
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| Status: |
Unpublished |
| Creators/Authors: |
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| ETD Committee: |
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| Date: |
14 December 2023 |
| Date Type: |
Publication |
| Defense Date: |
21 November 2023 |
| Approval Date: |
14 December 2023 |
| Submission Date: |
7 December 2023 |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
170 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Nursing > Nursing |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
Acute Post-Surgical Pain (APSP), Hysterectomy, Gynecologic Cancer, Pain Trajectories, Enhanced Recovery After Surgery (ERAS), Group-Based Trajectory Modeling, Postoperative Outcomes, Opioid Usage, Chronic Pain, High-Risk Cancer. |
| Date Deposited: |
14 Dec 2023 18:10 |
| Last Modified: |
14 Dec 2023 18:10 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/45616 |
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