title: Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery.
abstract: Chronic postsurgical pain (CPSP) is 1 important aspect of surgical recovery. To improve perioperative care and postoperative recovery knowledge on predictors of impaired recovery is essential. The aim of this study is to assess predictors and epidemiological data of CPSP, physical functioning (SF-36PF, 0-100), and global surgical recovery (global surgical recovery index, 0-100%) 3 and 12 months after hysterectomy for benign indication.A prospective multicenter cohort study was performed. Sociodemographic, somatic, and psychosocial data were assessed in the week before surgery, postoperatively up to day 4, and at 3- and 12-month follow-up. Generalized linear model (CPSP) and linear-mixed model analyses (SF-36PF and global surgical recovery index) were used. Baseline data of 468 patients were collected, 412 (88%) patients provided data for 3-month evaluation and 376 (80%) patients for 12-month evaluation.After 3 and 12 months, prevalence of CPSP (numeric rating scale ≥ 4, scale 0-10) was 10.2% and 9.0%, respectively, SF-36PF means (SD) were 83.5 (20.0) and 85.9 (20.2), global surgical recovery index 88.1% (15.6) and 93.3% (13.4). Neuropathic pain was reported by 20 (5.0%) patients at 3 months and 14 (3.9%) patients at 12 months. Preoperative pain, surgery-related worries, acute postsurgical pain on day 4, and surgery-related infection were significant predictors of CPSP. Baseline level, participating center, general psychological robustness, indication, acute postsurgical pain, and surgery-related infection were significant predictors of SF-36PF. Predictors of global surgical recovery were baseline expectations, surgery-related worries, American Society of Anesthesiologists classification, type of anesthesia, acute postsurgical pain, and surgery-related infection.Several predictors were identified for CPSP, physical functioning, and global surgical recovery. Some of the identified factors are modifiable and optimization of patients' preoperative pain status and psychological condition as well as reduction of acute postsurgical pain and surgery-related infection may lead to improvement of outcome.
authors.affiliation: aDepartment of Anesthesiology and Pain Management, Maastricht UMC+ bDepartment of Clinical Psychological Science, Maastricht University, Maastricht cDepartment of Gynecology, Máxima Medical Center, Veldhoven dDepartment of Gynaecology, Maastricht UMC+, Maastricht/Orbis Medical Center, Sittard-Geleen eDepartment of Anesthesiology and Pain Management, Catharina Hospital, Eindhoven, The Netherlands fDepartment of Anesthesiology, ICU, and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.
authors.forename: Maurice
authors.initials: M
authors.lastname: Theunissen
authors.forename: Madelon L
authors.initials: ML
authors.lastname: Peters
authors.forename: Jan
authors.initials: J
authors.lastname: Schepers
authors.forename: Jacques W M
authors.initials: JW
authors.lastname: Maas
authors.forename: Fleur
authors.initials: F
authors.lastname: Tournois
authors.forename: Hans A
authors.initials: HA
authors.lastname: van Suijlekom
authors.forename: Hans-Fritz
authors.initials: HF
authors.lastname: Gramke
authors.forename: Marco A E
authors.initials: MA
authors.lastname: Marcus
mesh_terms: D059350:Chronic Pain / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000009:adverse effects; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology* / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors