Age and preoperative pain are major confounders for sex differences in postoperative pain outcome: A prospective database analysis
Current literature is in disagreement regarding female sex as a risk factor for pain after surgery. We hypothesized, that sex differences exist but that they are influenced by certain factors. Here, we investigated the influence of sex for different clinically relevant postoperative pain (POP) outco...
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| creator | Zheng, Hua Schnabel, Alexander Yahiaoui-Doktor, Maryam Meissner, Winfried Van Aken, Hugo Zahn, Peter Pogatzki-Zahn, Esther |
| description | Current literature is in disagreement regarding female sex as a risk factor for pain after surgery. We hypothesized, that sex differences exist but that they are influenced by certain factors. Here, we investigated the influence of sex for different clinically relevant postoperative pain (POP) outcome parameters and evaluated the role of assumed confounders for sex differences.
From 1372 screened patients undergoing orthopedic surgery at the university hospital of Muenster between March 2010 and June 2011, 890 patients were included. The validated International Pain Outcomes questionnaire was used to assess the role of sex for several aspects of POP including pain severity, physical and emotional functional interference as well as the patient's perceptions of the care they received on the first day after surgery. Assessed confounders were age, preoperative chronic pain, anesthetic technique employed and surgical procedure. All statistical analyses were performed with SPSS Statistics Software 22.
Linear regression analysis demonstrated that sex was a statistically significant risk factor for "worst pain since surgery". Additionally, significant sex differences in "time spent in severe pain", "feeling anxious due to pain", "feeling helpless due to pain" and "opioid consumption since surgery" could be identified. An univariate general linear model showed that "age" and "preoperative pain" were significant confounders for sex differences. Further descriptive subgroup analysis revealed consistent sex differences for several POP outcome variables especially in patients older than 50 years or patients with preoperative chronic pain. However, sex differences disappeared in younger patients and in patients without preoperative pain.
Our data confirmed that sex differences exist in pain intensity and frequency, pain interference with feelings and opioid consumption during the first 24 hours postoperatively. However, sex differences were significantly influenced by the factors "age" and "preoperative pain". These findings may in part explain why clinical studies get different results related to sex differences and renders specific awareness in older women and female patients with preoperative chronic pain. |
| doi_str_mv | 10.1371/journal.pone.0178659 |
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From 1372 screened patients undergoing orthopedic surgery at the university hospital of Muenster between March 2010 and June 2011, 890 patients were included. The validated International Pain Outcomes questionnaire was used to assess the role of sex for several aspects of POP including pain severity, physical and emotional functional interference as well as the patient's perceptions of the care they received on the first day after surgery. Assessed confounders were age, preoperative chronic pain, anesthetic technique employed and surgical procedure. All statistical analyses were performed with SPSS Statistics Software 22.
Linear regression analysis demonstrated that sex was a statistically significant risk factor for "worst pain since surgery". Additionally, significant sex differences in "time spent in severe pain", "feeling anxious due to pain", "feeling helpless due to pain" and "opioid consumption since surgery" could be identified. An univariate general linear model showed that "age" and "preoperative pain" were significant confounders for sex differences. Further descriptive subgroup analysis revealed consistent sex differences for several POP outcome variables especially in patients older than 50 years or patients with preoperative chronic pain. However, sex differences disappeared in younger patients and in patients without preoperative pain.
Our data confirmed that sex differences exist in pain intensity and frequency, pain interference with feelings and opioid consumption during the first 24 hours postoperatively. However, sex differences were significantly influenced by the factors "age" and "preoperative pain". These findings may in part explain why clinical studies get different results related to sex differences and renders specific awareness in older women and female patients with preoperative chronic pain.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0178659</identifier><identifier>PMID: 28586373</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adult ; Age ; Age Factors ; Aged ; Analgesia - methods ; Analgesics, Opioid - administration & dosage ; Analysis ; Anesthetics - administration & dosage ; Biology and Life Sciences ; Care and treatment ; Chronic pain ; Computer programs ; Emotions ; Female ; Females ; Functional anatomy ; Gender aspects ; Gender differences ; Humans ; Interference ; Male ; Mathematical models ; Medicine and Health Sciences ; Middle Aged ; Narcotics ; Opioids ; Orthopedic surgery ; Orthopedics ; Pain ; Pain Management ; Pain, Postoperative - drug therapy ; Pain, Postoperative - physiopathology ; Patient outcomes ; Patients ; Postoperative pain ; Postoperative period ; Preoperative Period ; Regression analysis ; Risk assessment ; Risk factors ; Sex ; Sex Characteristics ; Sex differences ; Sex differences (Biology) ; Social Sciences ; Software ; Statistical analysis ; Statistics ; Surgery ; Surgical outcomes ; Treatment Outcome</subject><ispartof>PloS one, 2017-06, Vol.12 (6), p.e0178659-e0178659</ispartof><rights>COPYRIGHT 2017 Public Library of Science</rights><rights>2017 Zheng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2017 Zheng et al 2017 Zheng et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-76c8c13daf617af59371998cc8695c4b0ed3bd20e390e9501fd2d0050a06fc8f3</citedby><cites>FETCH-LOGICAL-c692t-76c8c13daf617af59371998cc8695c4b0ed3bd20e390e9501fd2d0050a06fc8f3</cites><orcidid>0000-0003-0981-3940</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460859/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460859/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79342,79343</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28586373$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zheng, Hua</creatorcontrib><creatorcontrib>Schnabel, Alexander</creatorcontrib><creatorcontrib>Yahiaoui-Doktor, Maryam</creatorcontrib><creatorcontrib>Meissner, Winfried</creatorcontrib><creatorcontrib>Van Aken, Hugo</creatorcontrib><creatorcontrib>Zahn, Peter</creatorcontrib><creatorcontrib>Pogatzki-Zahn, Esther</creatorcontrib><title>Age and preoperative pain are major confounders for sex differences in postoperative pain outcome: A prospective database analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Current literature is in disagreement regarding female sex as a risk factor for pain after surgery. We hypothesized, that sex differences exist but that they are influenced by certain factors. Here, we investigated the influence of sex for different clinically relevant postoperative pain (POP) outcome parameters and evaluated the role of assumed confounders for sex differences.
From 1372 screened patients undergoing orthopedic surgery at the university hospital of Muenster between March 2010 and June 2011, 890 patients were included. The validated International Pain Outcomes questionnaire was used to assess the role of sex for several aspects of POP including pain severity, physical and emotional functional interference as well as the patient's perceptions of the care they received on the first day after surgery. Assessed confounders were age, preoperative chronic pain, anesthetic technique employed and surgical procedure. All statistical analyses were performed with SPSS Statistics Software 22.
Linear regression analysis demonstrated that sex was a statistically significant risk factor for "worst pain since surgery". Additionally, significant sex differences in "time spent in severe pain", "feeling anxious due to pain", "feeling helpless due to pain" and "opioid consumption since surgery" could be identified. An univariate general linear model showed that "age" and "preoperative pain" were significant confounders for sex differences. Further descriptive subgroup analysis revealed consistent sex differences for several POP outcome variables especially in patients older than 50 years or patients with preoperative chronic pain. However, sex differences disappeared in younger patients and in patients without preoperative pain.
Our data confirmed that sex differences exist in pain intensity and frequency, pain interference with feelings and opioid consumption during the first 24 hours postoperatively. However, sex differences were significantly influenced by the factors "age" and "preoperative pain". These findings may in part explain why clinical studies get different results related to sex differences and renders specific awareness in older women and female patients with preoperative chronic pain.</description><subject>Adult</subject><subject>Age</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Analgesia - methods</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analysis</subject><subject>Anesthetics - administration & dosage</subject><subject>Biology and Life Sciences</subject><subject>Care and treatment</subject><subject>Chronic pain</subject><subject>Computer programs</subject><subject>Emotions</subject><subject>Female</subject><subject>Females</subject><subject>Functional anatomy</subject><subject>Gender aspects</subject><subject>Gender differences</subject><subject>Humans</subject><subject>Interference</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Medicine and Health Sciences</subject><subject>Middle Aged</subject><subject>Narcotics</subject><subject>Opioids</subject><subject>Orthopedic surgery</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Pain Management</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Pain, Postoperative - physiopathology</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Postoperative pain</subject><subject>Postoperative period</subject><subject>Preoperative Period</subject><subject>Regression analysis</subject><subject>Risk assessment</subject><subject>Risk factors</subject><subject>Sex</subject><subject>Sex Characteristics</subject><subject>Sex differences</subject><subject>Sex differences (Biology)</subject><subject>Social Sciences</subject><subject>Software</subject><subject>Statistical analysis</subject><subject>Statistics</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Treatment Outcome</subject><issn>1932-6203</issn><issn>1932-6203</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><sourceid>DOA</sourceid><recordid>eNqNk01r3DAQhk1padK0_6C0hkJpD7uVLFu2eigsoR8LgUC_rmIsjXa1eC1XskNy7S-vdtcJ65BD0cGy9LzvaEaaJHlJyZyykn7YuMG30Mw71-Kc0LLihXiUnFLBshnPCHt8ND9JnoWwIaRgFedPk5OsKirOSnaa_F2sMIVWp51H16GH3l5h2oFtU_CYbmHjfKpca9zQavQhNfE_4HWqrTHosVUY0gh3LvT39G7oldvix3QRzV3oUO33NPRQQ9hFheYm2PA8eWKgCfhi_J4lv758_nn-bXZx-XV5vriYKS6yflZyVSnKNBhOSzCFiEUQolKq4qJQeU1Qs1pnBJkgKApCjc50TJkA4UZVhp0lrw--XeOCHMsXJBWE55RzLiKxPBDawUZ23m7B30gHVu4XnF9J8L1VDUqDZcVoSVVmSC6yTGSc1IrWpsgV0FpHr09jtKHeolbY9h6aiel0p7VruXJXssg5qYrdYd6NBt79GTD0cmuDwqaBFt2wP3dJSCYYj-ibe-jD2Y3UCmICNl5pjKt2pnKRi7zgpNhT8weoODRubXwIaGxcnwjeTwSR6fG6X8EQglz--P7_7OXvKfv2iF0jNP06uGborWvDFMwPoIqvLHg0d0WmRO5a5bYactcqcmyVKHt1fEF3otveYP8ApFYQiw</recordid><startdate>20170606</startdate><enddate>20170606</enddate><creator>Zheng, Hua</creator><creator>Schnabel, Alexander</creator><creator>Yahiaoui-Doktor, Maryam</creator><creator>Meissner, Winfried</creator><creator>Van Aken, Hugo</creator><creator>Zahn, Peter</creator><creator>Pogatzki-Zahn, Esther</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISR</scope><scope>3V.</scope><scope>7QG</scope><scope>7QL</scope><scope>7QO</scope><scope>7RV</scope><scope>7SN</scope><scope>7SS</scope><scope>7T5</scope><scope>7TG</scope><scope>7TM</scope><scope>7U9</scope><scope>7X2</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABJCF</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>D1I</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB.</scope><scope>KB0</scope><scope>KL.</scope><scope>L6V</scope><scope>LK8</scope><scope>M0K</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>M7P</scope><scope>M7S</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PATMY</scope><scope>PDBOC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PTHSS</scope><scope>PYCSY</scope><scope>RC3</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-0981-3940</orcidid></search><sort><creationdate>20170606</creationdate><title>Age and preoperative pain are major confounders for sex differences in postoperative pain outcome: A prospective database analysis</title><author>Zheng, Hua ; Schnabel, Alexander ; Yahiaoui-Doktor, Maryam ; Meissner, Winfried ; Van Aken, Hugo ; Zahn, Peter ; Pogatzki-Zahn, Esther</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-76c8c13daf617af59371998cc8695c4b0ed3bd20e390e9501fd2d0050a06fc8f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Age</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Analgesia - 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We hypothesized, that sex differences exist but that they are influenced by certain factors. Here, we investigated the influence of sex for different clinically relevant postoperative pain (POP) outcome parameters and evaluated the role of assumed confounders for sex differences.
From 1372 screened patients undergoing orthopedic surgery at the university hospital of Muenster between March 2010 and June 2011, 890 patients were included. The validated International Pain Outcomes questionnaire was used to assess the role of sex for several aspects of POP including pain severity, physical and emotional functional interference as well as the patient's perceptions of the care they received on the first day after surgery. Assessed confounders were age, preoperative chronic pain, anesthetic technique employed and surgical procedure. All statistical analyses were performed with SPSS Statistics Software 22.
Linear regression analysis demonstrated that sex was a statistically significant risk factor for "worst pain since surgery". Additionally, significant sex differences in "time spent in severe pain", "feeling anxious due to pain", "feeling helpless due to pain" and "opioid consumption since surgery" could be identified. An univariate general linear model showed that "age" and "preoperative pain" were significant confounders for sex differences. Further descriptive subgroup analysis revealed consistent sex differences for several POP outcome variables especially in patients older than 50 years or patients with preoperative chronic pain. However, sex differences disappeared in younger patients and in patients without preoperative pain.
Our data confirmed that sex differences exist in pain intensity and frequency, pain interference with feelings and opioid consumption during the first 24 hours postoperatively. However, sex differences were significantly influenced by the factors "age" and "preoperative pain". These findings may in part explain why clinical studies get different results related to sex differences and renders specific awareness in older women and female patients with preoperative chronic pain.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>28586373</pmid><doi>10.1371/journal.pone.0178659</doi><tpages>e0178659</tpages><orcidid>https://orcid.org/0000-0003-0981-3940</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | PloS one, 2017-06, Vol.12 (6), p.e0178659-e0178659 |
| issn | 1932-6203 1932-6203 |
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| source | Public Library of Science (PLoS) Journals Open Access; MEDLINE; EZB Free E-Journals; PubMed Central; Directory of Open Access Journals; Free Full-Text Journals in Chemistry |
| subjects | Adult Age Age Factors Aged Analgesia - methods Analgesics, Opioid - administration & dosage Analysis Anesthetics - administration & dosage Biology and Life Sciences Care and treatment Chronic pain Computer programs Emotions Female Females Functional anatomy Gender aspects Gender differences Humans Interference Male Mathematical models Medicine and Health Sciences Middle Aged Narcotics Opioids Orthopedic surgery Orthopedics Pain Pain Management Pain, Postoperative - drug therapy Pain, Postoperative - physiopathology Patient outcomes Patients Postoperative pain Postoperative period Preoperative Period Regression analysis Risk assessment Risk factors Sex Sex Characteristics Sex differences Sex differences (Biology) Social Sciences Software Statistical analysis Statistics Surgery Surgical outcomes Treatment Outcome |
| title | Age and preoperative pain are major confounders for sex differences in postoperative pain outcome: A prospective database analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-04T16%3A47%3A33IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Age%20and%20preoperative%20pain%20are%20major%20confounders%20for%20sex%20differences%20in%20postoperative%20pain%20outcome:%20A%20prospective%20database%20analysis&rft.jtitle=PloS%20one&rft.au=Zheng,%20Hua&rft.date=2017-06-06&rft.volume=12&rft.issue=6&rft.spage=e0178659&rft.epage=e0178659&rft.pages=e0178659-e0178659&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0178659&rft_dat=%3Cgale_plos_%3EA494560569%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1906416669&rft_id=info:pmid/28586373&rft_galeid=A494560569&rft_doaj_id=oai_doaj_org_article_fe783171c2f049229260bc1bf54ca1bd&rfr_iscdi=true |