Of the 177 patients, 91 patients made an unsolicited call, clinic visit, or ED visit for pain issues. For 38 patients in this group, action was taken (additional prescription, imaging ordered, ED workup recommended or undertaken). For the other 53, no action was taken. From each group, some cases resolved because of further intervention, and some cases resolved without further action. Mesh use and preoperative pain scores were predictors of postop pain, but not age, ethnicity, sex, or other comorbidities. But 38 (21%) patients continued to have pain that was not resolved at 1 year, 32 of which had no actionable diagnosis.
The study was retrospective and limited by inclusion of visits and calls only to the surgical services and not to other medical services or physicians. Pain complaints were subjective and levels of severity were not recorded.
The investigators concluded that estimates of the number of patients who have chronic pain after cVHR do not capture the level of health care resource utilization for this problem. Patients experiencing postop pain make unscheduled calls or visits to the clinic or ED, and many do so repeatedly without receiving an actionable diagnosis. “A cost analysis specific to treating postoperative pain for 1 year would provide a better understanding of the magnitude of the problem. Subjective complaints of pain in the year following cVHR are frequent and represent a hidden driver of resource utilization which must be better understood to achieve optimal, cost effective care.”
The authors declared no conflicts of interest.
SOURCE: DeLong CG et al. Am J Surg. 2018. doi: 10.1016/j.amjsurg.2018.01.030.