title: The impact of patient-controlled analgesia on prognosis of patients receiving major abdominal surgery.
abstract: Postoperative pain is a major disease burden after surgery. Patient-controlled analgesia has been wide used for pain management in surgical patients, yet, large-scaled studies are lacking to assess its impact on the prognosis of patients.
  
  
  
  We prospectively enrolled patients who underwent major abdominal surgeries receiving patient-controlled analgesia (PCA) and who received non-PCA for assessment of 60-day mortality, major postoperative complications using electronic medical chart system. Pain intensity was also assessed with visual analogue scale from postoperative day 1 to day 7, chronic post-surgical pain was assessed by telephone follow-up using numerical rating scale.
  
  
  
  In total, 12,015 patients were included in the primary analysis. At the end of the follow-up, 1185 patients were lost to follow-up. Patients in the non-PCA group reported increased incidence of moderate-to-severe pain on postoperative day 3 (6.5% versus 9.6%, P<0.001). Patients receiving non-PCA had increased mortalities on postoperative 60-day (1.02% versus 0.47%, P<0.001). The survival probability of patients in PCA group was statistically higher than those in non-PCA group (99.52% [95% CI: 99.34-99.70%] versus 98.97% [95% CI: 98.73-99.92%]). Patient receiving non-PCA reported increased in-hospital major complications compared with (2.7% versus 1.9 %, P=0.003). Pain intensity was also assessed with visual analogue scale from postoperative day 1 to day 7, chronic post-surgical pain was assessed by telephone follow-up using numerical rating scale.
  
  
  
  Intravenous patient-controlled analgesia was related to improved survival, less complications and chronic post-surgical pain after major abdominal surgery, reiterating the important role of pain management for the prognosis of patients who underwent surgery.
authors.affiliation: Department of Anesthesia and Pain Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China - plhbest@163.com.
authors.forename: Lihua
authors.initials: L
authors.lastname: Peng
authors.forename: Li
authors.initials: L
authors.lastname: Ren
authors.forename: Peipei
authors.initials: P
authors.lastname: Qin
authors.forename: Min
authors.initials: M
authors.lastname: Su
mesh_terms: D000005:Abdomen / Q000601:surgery*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000401:mortality*; D000701:Analgesics, Opioid; D006801:Humans; D007275:Injections, Intravenous; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid