epidemiology and predictors of c Recovery 3 and 12 months after hysterectomy hronic pain , physical functioning , and global surgical recovery

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 3and 12-month follow-up. Generalized linear model (CPSP) and linearmixed 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 SF36PF. 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. Abbreviations:AIC = Akaike Information Criterion, ASA= American Society of Anesthesiologists, BPI-SF= Brief Pain Inventory— Short Form, CES-D = Center for Epidemiological Studies—Depression, CPSP = chronic postsurgical pain, CzE = Catharina Hospital, DN4-interview = Douleur neuropathique 4, self-reported items, GA = general anesthesia, IQR = interquartile range, 25th to 75th percentile, LAVH = laparoscopic assisted vaginal hysterectomy, LH = laparoscopic hysterectomy, LOT-R = Life Orientation Test—Revised, Maastricht UMC+ = Maastricht University Medical Center+, MMC = Máxima Medical Center, MOS-SSS = Medical Outcomes Study social support survey, NPP= neuropathic pain, NRS= numeric rating scale, OMC=Orbis Medical Center, PACU= postanesthesia care unit, PCS = Pain Catastrophizing Scale, SD = standard deviation, SF-36 PF = RAND health survey short-form 36, physical functioning, SFQ = Surgical Fear Questionnaire, W-BQ12 = Well-Being Questionnaire.