ACUTE PAIN AND RELATED OUTCOMES IN SURGICAL PATIENTS: RETROSPECTIVE ANALYSIS OF A LARGE US ELECTRONIC HEALTH RECORD DATABASE

OBJECTIVES: Adequate treatment of acute pain remains lacking in the postoperative setting. The objective of the study was to examine progression in postsurgical pain and association of pain with hospital length of stay (LOS), in a large sample of US surgical patients. METHODS: This study examined prospectively collected data from a US electronic health record database (Cemer HealthFacts™). Adult patients who underwent a wide range of surgical procedures (identified via ICD-9 coding) between January 2000 and March 2015 were included in the analysis. Patients were required to have at least one pain score (using a 0-10 numerical pain scale) prior to and following surgery. Baseline pain was assessed as the maximum pain score within 7 days prior to surgery and was used to stratify patients into mild, moderate or severe pain category. Pain on day of surgery and postsurgical days 1-14 was denned as the maximum pain score on each day. RESULTS: The study identified 110,145 surgical patients. Patients with severe baseline pain experienced a decrease in pain following surgery from a mean(SD) of 8.9(1.1) pre-surgery to 6.2 (3.3) on the day after. Patients with moderate baseline pain experienced minimal changes in pain, from a mean of 5.0(0.8) to 4.4(3.2) of the first day after surgery, and patients with no/mild pain experienced an increase following surgery from a mean pain of 0.7(1.2) to 3.0(3.3). There was an association between the baseline pain category and LOS such that patients with severe pain had, on average, the longest LOS (8.2 days), followed by patients with moderate pain (7.2 days), and no or mild pain (6.8 days). CONCLUSIONS: This analysis is suggestive of a needed improvement in management of mild-to-moderate postoperative pain and of a positive association between pre-surgical pain severity and LOS. These findings provide initial insights into potentially relevant risk factors in a broad surgical population.