title: Predictors for moderate to severe acute postoperative pain after total hip and knee replacement.
abstract: OBJECTIVE
  The ability to identify and focus care to patients at higher risk of moderate to severe postoperative pain should improve analgesia and patient satisfaction, and may affect reimbursement. We undertook this multi-centre cross-sectional study to identify preoperative risk factors for moderate to severe pain after total hip (THR) and knee (TKR) replacement.
  
  
  METHODS
  A total of 897 patients were identified from electronic medical records. Preoperative information and anaesthetic technique was gained by retrospective chart review. The primary outcomes were moderate to severe pain (pain score ≥ 4/10) at rest and with activity on postoperative day one. Logistic regression was performed to identify predictors for moderate to severe pain.
  
  
  RESULTS
  Moderate to severe pain was reported by 20 % at rest and 33 % with activity. Predictors for pain at rest were female gender (OR 1.10 with 95 % CI 1.01-1.20), younger age (0.96, 0.94-0.99), increased BMI (1.02, 1.01-1.03), TKR vs. THR (3.21, 2.73-3.78), increased severity of preoperative pain at the surgical site (1.15, 1.03-1.30), preoperative use of opioids (1.63, 1.32-2.01), and general anaesthesia (8.51, 2.13-33.98). Predictors for pain with activity were TKR vs. THR (1.42, 1.28-1.57), increased severity of preoperative pain at the surgical site (1.11, 1.04-1.19), general anaesthesia (9.02, 3.68-22.07), preoperative use of anti-convulsants (1.78, 1.32-2.40) and anti-depressants (1.50, 1.08-2.80), and prior surgery at the surgical site (1.28, 1.05-1.57).
  
  
  CONCLUSIONS
  Our findings provide clinical guidance for preoperative stratification of patients for more intensive management potentially including education, nursing staffing, and referral to specialised pain management.
authors: Department of Anesthesiology, Hospital for Special Surgery and Weill Cornell Medical College, 535 East 70th St., New York, NY 10021, USA. anessl@yahoo.com
authors: Spencer S
authors: SS
authors: Liu
authors: Asokumar
authors: A
authors: Buvanendran
authors: James P
authors: JP
authors: Rathmell
authors: Mona
authors: M
authors: Sawhney
authors: James J
authors: JJ
authors: Bae
authors: Mario
authors: M
authors: Moric
authors: Stephen
authors: S
authors: Perros
authors: Ashley J
authors: AJ
authors: Pope
authors: Lazaros
authors: L
authors: Poultsides
authors: Craig J
authors: CJ
authors: Della Valle
authors: Naomi S
authors: NS
authors: Shin
authors: Colin J L
authors: CJ
authors: McCartney
authors: Yan
authors: Y
authors: Ma
authors: Mahendrakumar
authors: M
authors: Shah
authors: Monica J
authors: MJ
authors: Wood
authors: Smith C
authors: SC
authors: Manion
authors: Thomas P
authors: TP
authors: Sculco
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D003430:Cross-Sectional Studies; D005260:Female; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D014218:Triage / Q000379:methods*