title: Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures.
abstract: BACKGROUND
  Severe pain after surgery remains a major problem, occurring in 20-40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified.
  
  
  METHODS
  This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0-10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared.
  
  
  RESULTS
  The 40 procedures with the highest pain scores (median numeric rating scale, 6-7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many "minor" surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of "major" abdominal surgeries resulted in comparatively low pain scores, often because of sufficient epidural analgesia.
  
  
  CONCLUSIONS
  Several common minor- to medium-level surgical procedures, including some with laparoscopic approaches, resulted in unexpectedly high levels of postoperative pain. To reduce the number of patients suffering from severe pain, patients undergoing so-called minor surgery should be monitored more closely, and postsurgical pain treatment needs to comply with existing procedure-specific pain-treatment recommendations.
authors: Department of Anesthesiology and Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands. h.j.gerbershagen@umcutrecht.nl
authors: Hans J
authors: HJ
authors: Gerbershagen
authors: Sanjay
authors: S
authors: Aduckathil
authors: Albert J M
authors: AJ
authors: van Wijck
authors: Linda M
authors: LM
authors: Peelen
authors: Cor J
authors: CJ
authors: Kalkman
authors: Winfried
authors: W
authors: Meissner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005858:Germany; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis* / Q000209:etiology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000706:statistics & numerical data*; D055815:Young Adult