The Association Between Pain and In-Hospital Complications and Duration of Stay After Colorectal Surgery

Noga Avrahami; Batya Betesh-Abay; Abed N Azab; Tatiana Nisimov; Muhammad Abu Tailakh

doi:10.1016/j.pmn.2022.01.002

The Association Between Pain and In-Hospital Complications and Duration of Stay After Colorectal Surgery

Pain Manag Nurs. 2022 Dec;23(6):848-854. doi: 10.1016/j.pmn.2022.01.002. Epub 2022 Feb 6.

Authors

Noga Avrahami¹, Batya Betesh-Abay², Abed N Azab³, Tatiana Nisimov⁴, Muhammad Abu Tailakh⁵

Affiliations

¹ Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel and Soroka University Medical Center, Beer-Sheva, Israel; High Risk Pregnancy Department, Baruch Padeh Medical Center, Poriya, Tiberias, Israel.
² Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel and Soroka University Medical Center, Beer-Sheva, Israel.
³ Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel and Soroka University Medical Center, Beer-Sheva, Israel; Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
⁴ Division of Surgery, Soroka University Medical Center, Beer-Sheva, Israel.
⁵ Recanati School for Community Health Professions, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel and Soroka University Medical Center, Beer-Sheva, Israel. Electronic address: abutaila@bgu.ac.il.

PMID: 35140054
DOI: 10.1016/j.pmn.2022.01.002

Abstract

Background: Pain is a subjective and multidimensional experience often inadequately managed following surgery. Postoperative pain has been shown to correlate with hospital length of stay (HLOS) and hospital complications. Given advancements in preemptive pain management approaches, reevaluation is necessary.

Aims: The purpose of this study was to examine the association between postoperative pain intensity and HLOS and in-hospital complications among patients who underwent colorectal surgery, adjusted by sociodemographic and underlying medical variables.

Setting and patients: We used electronic medical records. Data were collected from patients who underwent colorectal surgery at a large general hospital in Israel from January 2012 to December 2018.

Design and methods: This is a retrospective cohort study. Information on HLOS, medical diagnoses, pain intensity, use of analgesics, postoperative infections, patient sociodemographic data, chronic diseases, functionality status, and source of admission were extracted from medical records. Logistic regression analysis was used for the final model, and HLOS and in-hospital complications were the major outcomes.

Results: We enrolled 1,073 patients. Of them, 554 males (51.6%) with a mean age of 62.54 ± 16.55 years. The median postoperative pain score was 1.54 (interquartile range, 0.84; 2.16), and an in-hospital complication rate of 1.3% (n = 14). Postoperative pain was not associated with prolonged HLOS with adjustment to relevant independent variables (odds ratio, 1.399; 95% confidence interval, 0.759-2.578; p = .282). Contrarily, age, malignancy, assistance needed in activities of daily living, use of analgesic agents, and postoperative infection were risk factors for prolonged HLOS. Additionally, postoperative pain was not related to a higher risk of in-hospital complications.

Conclusions: Pain intensity post colorectal surgery was not a risk factor for extended HLOS or in-hospital complications. In contradistinction, tending to patient needs, adequate analgesic use, and reducing infection rates can shorten HLOS, improve health outcomes, and economize health care resources.

Keywords: Colorectal surgery; Hospital length of stay; In-hospital complications; Pain; Visual analog scale.

MeSH terms

Activities of Daily Living*
Aged
Colorectal Neoplasms* / complications
Colorectal Neoplasms* / surgery
Hospitals
Humans
Length of Stay
Male
Middle Aged
Pain, Postoperative
Postoperative Complications / etiology
Retrospective Studies