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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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29-02-2024 | Sternotomy | Reports of Original Investigations

Association of chronic poststernotomy pain and health-related quality of life: a prospective cohort study

Authors: Terri Sun, MD, FRCPC, Mikayla Fan, BSc, Defen Peng, PhD, Lauren Li, BSc, Alyson Ree, BSc, Alana M. Flexman, MD, FRCPC, MBA, Ainsley M. Sutherland, MD, PhD, FRCPC, Stephan K. W. Schwarz, MD, PhD, FRCPC, Tim Ting Han Jen, MD, FRCPC, Cynthia H. Yarnold, MD, FRCPC

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 5/2024

Abstract

Purpose

Chronic poststernotomy pain (CPSP) after cardiac surgery is multifactorial and impacts patient recovery. We aimed to evaluate the association between CPSP severity and health-related quality of life at six months after cardiac surgery.

Methods

This was a single-centre prospective cohort study of patients who underwent cardiac surgery with median sternotomy between September 2020 and March 2021. Telephone interviews were conducted at six and 12 months postoperatively using the Short Form McGill Pain Questionnaire and the EQ-5D-5L. Strength of correlation was described using Spearman’s correlation coefficient. Multivariable regression analysis was used to account for confounding variables.

Results

A total of 252 patients responded to the six-month interview (response rate, 65%). The mean (standard deviation) age of respondents was 65 (13) yr. Twenty-nine percent of respondents (72/252) reported CPSP at six months, and 14% (41/252) reported more than mild pain (score ≥ 2/5). At 12 months, of the 89% (64/72) patients who responded, 47% (30/64) still reported pain. The strength of the correlation between pain scores and EQ-5D-5L was weak (Spearman’s correlation coefficient, −0.3). Risk factors for CPSP at six months included higher pain score on postoperative day 1, history of chronic pain prior to surgery, and history of depression. Intraoperative infusion of dexmedetomidine or ketamine was associated with a reduced risk of CPSP at six months.

Conclusion

Chronic poststernotomy pain still affects patient recovery at six and 12 months after cardiac surgery. The severity of that pain is poorly correlated with patients’ quality of life.

Study registration

www.osf.io (https://osf.io/52rsw); registered 14 May 2022.

Available only for authorised users

EuroQol Research Foundation. EQ-5D-5L. Available from URL: https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/ (accessed November 2023).

Kleiman AM, Sanders DT, Nemergut EC, Huffmyer JL. Chronic poststernotomy pain: incidence, risk factors, treatment, prevention, and the anesthesiologist's role. Reg Anesth Pain Med 2017; 42: 698–708. https://doi.org/10.1097/aap.0000000000000663CrossRefPubMed

Elmistekawy E, Attia A. Chronic post sternotomy pain: the role of sternal wire removal—a review. AME Med J 2020; 5: 31. https://doi.org/10.21037/amj.2020.03.06CrossRef

Taillefer MC, Carrier M, Bélisle S, et al. Prevalence, characteristics, and predictors of chronic nonanginal postoperative pain after a cardiac operation: a cross-sectional study. J Thorac Cardiovasc Surg 2006; 131: 1274–80. https://doi.org/10.1016/j.jtcvs.2006.02.001CrossRefPubMed

Mailis A, Umana M, Feindel CM. Anterior intercostal nerve damage after coronary artery bypass graft surgery with use of internal thoracic artery graft. Ann Thorac Surg 2000; 69: 1455–8. https://doi.org/10.1016/s0003-4975(00)01186-3CrossRefPubMed

Boodhwani M, Lam BK, Nathan HJ, et al. Skeletonized internal thoracic artery harvest reduces pain and dysesthesia and improves sternal perfusion after coronary artery bypass surgery: a randomized, double-blind, within-patient comparison. Circulation 2006; 114: 766–73. https://doi.org/10.1161/circulationaha.106.615427CrossRefPubMed

Defalque RJ, Bromley JJ. Poststernotomy neuralgia: a new pain syndrome. Anesth Analg 1989; 69: 81–2.CrossRefPubMed

Woodring JH, Royer JM, Todd EP. Upper rib fractures following median sternotomy. Ann Thorac Surg 1985; 39: 355–7. https://doi.org/10.1016/s0003-4975(10)62631-8CrossRefPubMed

Van Leersum NJ, Van Leersum RL, Verwey HF, Klautz RJ. Pain symptoms accompanying chronic poststernotomy pain: a pilot study. Pain Med 2010; 11: 1628–34. https://doi.org/10.1111/j.1526-4637.2010.00975.xCrossRefPubMed

Alston RP, Pechon P. Dysaesthesia associated with sternotomy for heart surgery. Br J Anaesth 2005; 95: 153–8. https://doi.org/10.1093/bja/aei152CrossRefPubMed

10.

Marcassa C, Faggiano P, Greco C, Ambrosetti M, Temporelli PL, Italian Association of Cardiovascular Prevention, Rehabilitation. A retrospective multicenter study on long-term prevalence of chronic pain after cardiac surgery. J Cardiovasc Med (Hagerstown) 2015; 16: 768–74. https://doi.org/10.2459/jcm.0000000000000271

11.

Kamalipour H, Vafaei A, Kazemi AP, Khademi S. Comparing the prevalence of chronic pain after sternotomy in patients undergoing coronary artery bypass grafting using the internal mammary artery and other open heart surgeries. Anesth Pain Med 2014; 4: e17969. https://doi.org/10.5812/aapm.17969CrossRefPubMedPubMedCentral

12.

Guimarães-Pereira L, Farinha F, Azevedo L, Abelha F, Castro-Lopes J. Persistent postoperative pain after cardiac surgery: incidence, characterization, associated factors and its impact in quality of life. Eur J Pain 2016; 20: 1433–42. https://doi.org/10.1002/ejp.866CrossRefPubMed

13.

Gjeilo KH, Stenseth R, Klepstad P. Risk factors and early pharmacological interventions to prevent chronic postsurgical pain following cardiac surgery. Am J Cardiovasc Drugs 2014; 14: 335–42. https://doi.org/10.1007/s40256-014-0083-2CrossRefPubMed

14.

Turan A, Belley-Cote EP, Vincent J, et al. Methylprednisolone does not reduce persistent pain after cardiac surgery. Anesthesiology 2015; 123: 1404–10. https://doi.org/10.1097/aln.0000000000000915CrossRefPubMed

15.

Van Gulik L, Janssen LI, Ahlers SJ, et al. Risk factors for chronic thoracic pain after cardiac surgery via sternotomy. Eur J Cardiothorac Surg 2011; 40: 1309–13. https://doi.org/10.1016/j.ejcts.2011.03.039CrossRefPubMed

16.

Lahtinen P, Kokki H, Hynynen M. Pain after cardiac surgery: a prospective cohort study of 1-year incidence and intensity. Anesthesiology 2006; 105: 794–800. https://doi.org/10.1097/00000542-200610000-00026CrossRefPubMed

17.

Villa G, Mandarano R, Scirè-Calabrisotto C, et al. Chronic pain after breast surgery: incidence, associated factors, and impact on quality of life, an observational prospective study. Perioper Med (Lond) 2021; 10: 6. https://doi.org/10.1186/s13741-021-00176-6CrossRefPubMed

18.

Loxe SC, de Mello LS, Camara L, et al. Chronic pain after lung transplantation and its impact on quality of life: a 4-year follow-up. Transplant Proc 2020; 52: 1388–93. https://doi.org/10.1016/j.transproceed.2020.02.032CrossRefPubMed

19.

Von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med 2007; 147: 573–7. https://doi.org/10.7326/0003-4819-147-8-200710160-00010CrossRef

20.

Gilbert EH, Lowenstein SR, Koziol-McLain J, Barta DC, Steiner J. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med 1996; 27: 305–8. https://doi.org/10.1016/s0196-0644(96)70264-0CrossRefPubMed

21.

Worster A, Bledsoe RD, Cleve P, Fernandes CM, Upadhye S, Eva K. Reassessing the methods of medical record review studies in emergency medicine research. Ann Emerg Med 2005; 45: 448–51. https://doi.org/10.1016/j.annemergmed.2004.11.021CrossRefPubMed

22.

Melzack R. The short-form McGill pain questionnaire. Pain 1987; 30: 191–7. https://doi.org/10.1016/0304-3959(87)91074-8CrossRefPubMed

23.

Heiskanen J, Tolppanen AM, Roine RP, et al. Comparison of EQ-5D and 15D instruments for assessing the health-related quality of life in cardiac surgery patients. Eur Heart J Qual Care Clin Outcomes 2016; 2: 193–200. https://doi.org/10.1093/ehjqcco/qcw002CrossRefPubMed

24.

Gjeilo K, Klepstad P, Wahba A, Lydersen S, Stenseth R. Chronic pain after cardiac surgery: a prospective study. Acta Anaesthesiol Scand 2010; 54: 70–8. https://doi.org/10.1111/j.1399-6576.2009.02097.xCrossRefPubMed

25.

Harrogate SR, Cooper JA, Zawadka M, Anwar S. Seven‐year follow‐up of persistent postsurgical pain in cardiac surgery patients: a prospective observational study of prevalence and risk factors. Eur J Pain 2021; 25: 1829–38. https://doi.org/10.1002/ejp.1794CrossRefPubMed

26.

Leventhal H, Colman S. Quality of life: a process view. Psychol Health 1997; 12: 753–67. https://doi.org/10.1080/08870449708406737CrossRef

27.

Rapkin BD, Schwartz CE. Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift. Health Qual Life Outcomes 2004; 2: 14. https://doi.org/10.1186/1477-7525-2-14CrossRefPubMedPubMedCentral

28.

Choinière M, Watt-Watson J, Victor JC, et al. Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study. CMAJ 2014; 186: E213-23. https://doi.org/10.1503/cmaj.131012CrossRefPubMedPubMedCentral

29.

Cray da Costa MA, Trentini CA, Schafranski MD, Pipino O, Gomes RZ, Souza dos Santos Reis E. Factors associated with the development of chronic post-sternotomy pain: a case-control study. Braz J Cardiovasc Surg 2015; 30: 552–6. https://doi.org/10.5935/1678-9741.20150059

30.

Chaparro LE, Smith SA, Moore RA, Wiffen PJ, Gilron I. Pharmacotherapy for the prevention of chronic pain after surgery in adults. Cochrane Database Syst Rev 2013; 2013: CD008307. https://doi.org/10.1002/14651858.cd008307.pub2

31.

Cameron M, Tam K, Al Wahaibi K, Charghi R, Béïque F. Intraoperative ketamine for analgesia post-coronary artery bypass surgery: a randomized, controlled, double-blind clinical trial. J Cardiothorac Vasc Anesth 2020; 34: 586–91. https://doi.org/10.1053/j.jvca.2019.10.010CrossRefPubMed

32.

Fan W, Xue H, Sun Y, et al. Dexmedetomidine improves postoperative patient-controlled analgesia following radical mastectomy. Front Pharmacol 2017; 8: 250. https://doi.org/10.3389/fphar.2017.00250CrossRefPubMedPubMedCentral

33.

Tufanogullari B, White PF, Peixoto MP, et al. Dexmedetomidine infusion during laparoscopic bariatric surgery: the effect on recovery outcome variables. Anesth Analg 2008; 106: 1741–8. https://doi.org/10.1213/ane.0b013e318172c47cCrossRefPubMed

34.

Ge DJ, Qi B, Tang G, Li JY. Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after abdominal hysterectomy: a double-blind, randomized clinical trial. Sci Rep 2016; 6: 21514. https://doi.org/10.1038/srep21514CrossRefPubMedPubMedCentral

35.

Ge DJ, Qi B, Tang G, Li JY. Intraoperative dexmedetomidine promotes postoperative analgesia and recovery in patients after abdominal colectomy: a CONSORT-prospective, randomized, controlled clinical trial. Medicine (Baltimore) 2015; 94: e1727. https://doi.org/10.1097/md.0000000000001727CrossRefPubMed

36.

Rajan S, Hutcherson MT, Sessler DI, et al. The effects of dexmedetomidine and remifentanil on hemodynamic stability and analgesic requirement after craniotomy: a randomized controlled trial. J Neurosurg Anesthesiol 2016; 28: 282–90. https://doi.org/10.1097/ana.0000000000000221CrossRefPubMed

37.

Naik BI, Nemergut EC, Kazemi A, et al. The effect of dexmedetomidine on postoperative opioid consumption and pain after major spine surgery. Anesth Analg 2016; 122: 1646–53. https://doi.org/10.1213/ane.0000000000001226CrossRefPubMed

38.

Lee HS, Yoon HY, Jin HJ, Hwang SH. Can dexmedetomidine influence recovery profiles from general anesthesia in nasal surgery? Otolaryngol Head Neck Surg 2018; 158: 43–53. https://doi.org/10.1177/0194599817733735CrossRefPubMed

39.

Patel M, Onwochei DN, Desai N. Influence of perioperative dexmedetomidine on the incidence of postoperative delirium in adult patients undergoing cardiac surgery. Br J Anaesth 2022; 129: 67–83. https://doi.org/10.1016/j.bja.2021.11.041CrossRefPubMed

40.

Ji F, Li Z, Nguyen H, et al. Perioperative dexmedetomidine improves outcomes of cardiac surgery. Circulation 2013; 127: 1576–84. https://doi.org/10.1161/circulationaha.112.000936CrossRefPubMedPubMedCentral

41.

Peng K, Shen YP, Ying YY, et al. Perioperative dexmedetomidine and 5-year survival in patients undergoing cardiac surgery. Br J Anaesth 2021; 127: 215–23. https://doi.org/10.1016/j.bja.2021.03.040CrossRefPubMed

42.

Soneji N, Clarke HA, Ko DT, Wijeysundera DN. Risks of developing persistent opioid use after major surgery. JAMA Surg 2016; 151: 1083–4. https://doi.org/10.1001/jamasurg.2016.1681CrossRefPubMed

43.

Rumsfeld JS, Magid DJ, O’Brien M, et al. Changes in health-related quality of life following coronary artery bypass graft surgery. Ann Thorac Surg 2001; 72: 2026–32. https://doi.org/10.1016/s0003-4975(01)03213-1CrossRefPubMed

44.

Mehaffey JH, Hayanga JA, Kawsara M, et al. Contemporary coronary artery bypass grafting versus multivessel percutaneous coronary intervention. Ann Thorac Surg 2023; 116: 1213–20. https://doi.org/10.1016/j.athoracsur.2023.05.032CrossRefPubMed

45.

Katz J, Weinrib A, Fashler SR, et al. The Toronto General Hospital Transitional Pain Service: development and implementation of a multidisciplinary program to prevent chronic postsurgical pain. J Pain Res 2015; 8: 695–702. https://doi.org/10.2147/jpr.s91924CrossRefPubMedPubMedCentral

Title: Association of chronic poststernotomy pain and health-related quality of life: a prospective cohort study
Authors: Terri Sun, MD, FRCPC
Mikayla Fan, BSc
Defen Peng, PhD
Lauren Li, BSc
Alyson Ree, BSc
Alana M. Flexman, MD, FRCPC, MBA
Ainsley M. Sutherland, MD, PhD, FRCPC
Stephan K. W. Schwarz, MD, PhD, FRCPC
Tim Ting Han Jen, MD, FRCPC
Cynthia H. Yarnold, MD, FRCPC
Publication date: 29-02-2024
Publisher: Springer International Publishing
Keywords: Sternotomy
Heart Surgery
Heart Surgery
Opioids
Opioids
Ketamine
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 5/2024
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-024-02706-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association of chronic poststernotomy pain and health-related quality of life: a prospective cohort study

Abstract

Purpose

Methods

Results

Conclusion

Study registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Study registration

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