Background and Goal of Study:  Postoperative pain occurs at a high incidence with many patients reporting moderate to severe pain. Our study aimed to determine the incidence of severe pain after surgery in an elderly population, and to characterize and evaluate its related outcome.
Materials and Methods: We conducted an observational prospective study after approval by the Institutional ethics committee. Patients aged >60 years, submitted to elective surgery from May to July 2017 were included. Data collection included comorbidities and the perioperative use of drugs. The burden of comorbidity was quantified using the Charlson Comorbidity Index. The physiological and operative severity score for the enumeration of mortality and morbidity score (POSSUM) was used to determine operative morbidity and mortality risk. The Quality of Recovery 15-item (QoR-15) was calculated before surgery (T0) and 24 hours after surgery (T1). Patients reporting to have severe pain in QoR-15 were considered Patients With Severe Pain (PWP). The Health-related Quality of Life (EQ-5D) measure health-related quality of life at 3 months follow-up (M3). The Mann-Whitney test, Chi-square or Fisher’s exact test were used for comparison
Results and Discussion: Of a total of 235 patients, 24% were PWP. These patients were more frequently women (68% vs 50%, p=0.017), had more frequently history of psychiatric disorders (23% vs 11%, p=0.024) and previous surgery on the same incision site (29% vs 15%, p=0.023). Neither POSSUM score (p=0.826), operative risk of mortality (p=0.846), morbidity (0.981) or Charlson score were different (p=0.808). PWP more frequently had tramadol at the PACU and had a more often use of tramadol (p=0.005) and benzodiazepines (p=0.032) in the first day after surgery. Rates of opiods use during surgery and at PACU were comparable to other patients. PWP had a higher median total QoR-15 at T0 (p=0.002) and at T1 (p<0.001). PWP have longer duration of surgery (p=0.007) and longer lengths of stay at the hospital (p=0.014). PWP had similar rate of problems at all EQ-5D dimensions at M3 including problems with pain (p=0.724).
Conclusions: The incidence of severe pain was considerably high after surgery. PWP have no more comorbidities and have similar risk for mortality and comorbidities. The use of tramadol and benzodiazepines after surgery was more frequent in PWP. PWP experienced a worse quality of recovery after surgery with longer lengths of hospital stay.


05 / Severe pain 24 hours after surgery in elderly patients.