No Differences in the Prevalence and Intensity of Chronic Postsurgical Pain Between Laparoscopic Hysterectomy and Abdominal Hysterectomy: A Prospective Study

Figures & data

Figure 1 Flowchart of participants throughout the study.

Table 1 Perioperative Variables of LH vs AH Groups

Variable	LH (n=225)	AH (n=181)	P
Age (years, mean ± SD)	44.0±7.2	43.2±6.8	0.254
Height (cm, mean ± SD)	158.6±4.1	158.5±4.3	0.779
Weight (kg, mean ± SD)	58.7±7.3	58.0±7.8	0.308
Body mass index (kg/m^2, mean ± SD)	23.3±2.8	23.1±2.9	0.325
Marital status, n (%)			0.214
Married	195 (86.7)	148 (81.8)
Unmarried	30 (13.3)	33 (18.2)
Employment status, n (%)			0.249
Employed	114 (50.7)	106 (58.6)
Unemployed	76 (33.8)	54 (29.8)
Retired	35 (15.6)	21 (11.6)
Education level, n (%)			0.626
≤High school diploma	17 (7.6)	10 (5.5)
Professional school diploma	151 (67.1)	120 (66.3)
University/postgraduate degree	57 (25.3)	51 (8.2)
Number of pregnancies (n, mean ± SD)	3.5±1.3	3.5±1.3	0.819
Previous abdominal or pelvic surgery, n (%)	31 (13.8)	30 (16.6)	0.485
Previous vaginal delivery, n (%)	145 (64.4)	119 (65.7)	0.834
Previous cesarean delivery, n (%)	91 (40.4)	71 (39.2)	0.839
Preoperative pelvic pain, n (%)	67 (29.8)	58 (32.0)	0.666
Preoperative pain in other body regions, n (%)	20 (8.9)	10 (5.5)	0.253
Main indication for hysterectomy, n (%)			0.340
Leiomyoma	148 (65.8)	114 (63.0)
Menorrhagia and/or metrorrhagia	37 (16.4)	22 (12.2)
Endometriosis	13 (5.8)	16 (8.8)
Cervical dysplasia	20 (8.9)	24 (13.3)
Other	7 (3.1)	5 (2.8)
ASA physical status, n (%)			0.786
I	143 (63.6)	120 (66.3)
II	73 (32.4)	53 (29.3)
III	9 (4.0)	8 (4.4)
Duration of surgery (min, mean ± SD)	121±23	124±20	0.188
Blood loss (mL, mean ± SD)	95±40	112±38	<0.001
Weight of uterus (g, mean ± SD)	181±105	176±112	0.679
Average pain intensity at rest within 24 h after surgery (mean ± SD)	1.7±0.6	1.7±0.6	0.632
Average pain intensity on movement within 24 h after surgery (mean ± SD)	3.3±0.8	4.1±1.3	<0.001
Pain at 3 months, n (%)	47 (20.9)	37 (20.4)	0.912
Pain at 6 months, n (%)	26 (11.6)	17 (9.4)	0.767
Pain at 12 months, n (%)	13 (5.8)	11 (6.1)	0.404

Abbreviations: LH, laparoscopic hysterectomy; AH, abdominal hysterectomy; ASA, American Society of Anesthesiologists.

Table 2 Characteristics of Pain 3, 6 and 12 Months After Surgery

	Pain at 3 Months			Pain at 6 Months			Pain at 12 Months
	LH (n=47)	AH (n=37)	P	LH (n=26)	AH (n=17)	P	LH (n=13)	AH (n=11)	P
Pain severity
Pain at rest in past week
NRS score (mean ± SD)	2.4±1.1	2.6±1.0	0.426	1.7±0.8	1.9±0.9	0.490	1.5±0.7	1.6±0.9	0.595
			0.877			0.653			0.267
Mild pain, n (%)	35 (74.5)	27 (73.0)		24 (92.3)	15 (88.2)		13 (100)	10 (90.9)
Moderate pain, n (%)	12 (25.5)	10 (27.0)		2 (7.7)	2 (11.8)		0	1 (9.1)
Severe pain, n (%)	0	0		0	0		0	0
Pain during movement in past week
NRS score (mean ± SD)	3.6±1.3	4.2±1.4	0.074	2.7±0.9	3.1±1.4	0.272	2.5±0.7	2.8±0.8	0.342
			0.958			0.278			0.439
Mild pain, n (%)	25 (53.2)	19 (51.4)		20 (76.9)	10 (58.8)		12 (92.3)	9 (81.8)
Moderate pain, n (%)	19 (40.4)	16 (43.2)		6 (23.1)	6 (35.3)		1 (7.7)	2 (18.2)
Severe pain, n (%)	3 (6.4)	2 (5.4)		0	1 (5.9)		0	0
Analgesic required, n (%)	13 (27.7)	12 (32.4)	0.635	5 (19.2)	4 (23.5)	0.735	2 (15.4)	2 (18.2)	0.855
Pain frequency, n (%)
			0.772			0.955			0.474
Constantly	5 (10.6)	7 (18.9)		2 (7.7)	2 (11.8)		0	1 (9.1)
Daily	22 (46.8)	15 (40.5)		7 (26.9)	3 (17.6)		2 (15.4)	2 (18.2)
Several times/week	13 (27.7)	11 (29.7)		13 (50.0)	9 (52.9)		2 (15.4)	4 (36.4)
Once a week	4 (8.5)	3 (8.1)		3 (11.5)	2 (11.8)		6 (46.2)	3 (27.3)
Less than once a week	3 (6.4)	1 (2.7)		1 (3.8)	1 (5.9)		3 (23.1)	1 (9.1)
Main location of pain, n (%)
			0.343			0.695			0.835
Area of incision	15 (31.9)	20 (54.1)		7 (26.9)	5 (29.4)		4 (30.8)	3 (27.3)
Pelvis	22 (46.8)	10 (27.0)		8 (30.8)	6 (35.3)		5 (38.5)	4 (36.4)
Low back	4 (8.5)	2 (5.4)		5 (19.2)	3 (17.6)		2 (15.4)	2 (18.2)
Vagina	3 (6.4)	2 (5.4)		4 (15.4)	2 (11.8)		1 (7.7)	1 (9.1)
Groin	2 (4.3)	1 (2.7)		2 (7.7)	0		0	1 (9.1)
Other	1 (2.1)	2 (5.4)		0	1 (5.9)		1 (7.7)	0

Abbreviation: NRS, numerical rating scale.

Table 3 The Activities of Daily Living Affected by Chronic Pain, and the Extent of the Perceived Interference

Activity	3 Months After Surgery						6 Months After Surgery						12 Months After Surgery
	Patients who stated that pain had some effect on this activity (n, %)			NRS score (mean ± SD)			Patients who stated that pain had some effect on this activity (n, %)			NRS score (mean ± SD)			Patients who stated that pain had some effect on this activity (n, %)			NRS score (mean ± SD)
	LH (n=47)	AH (n=37)	P	LH (n=47)	AH (n=37)	P	LH (n=26)	AH (n=17)	P	LH (n=26)	AH (n=17)	P	LH (n=13)	AH (n=11)	P	LH (n=13)	AH (n=11)	P
General activity	33 (70.2)	27 (73.0)	0.781	2.3±1.8	2.7±2.0	0.367	15 (57.7)	9 (52.9)	0.759	1.4±1.4	1.7±2.0	0.480	6(46.2)	5(45.5)	0.973	1.1±1.3	1.0±1.2	0.883
Mood	40 (85.1)	33 (89.2)	0.582	2.6±1.6	3.1±1.4	0.162	20 (76.9)	12 (70.6)	0.642	1.7±1.1	1.7±1.4	0.827	7 (53.8)	5 (45.5)	0.682	1.3±1.3	1.2±1.5	0.827
Walking ability	31 (66.0)	28 (75.7)	0.333	1.7±1.5	2.1±1.5	0.274	13 (50.0)	9 (52.9)	0.850	1.0±1.2	1.0±1.3	0.810	4 (30.8)	3 (27.3)	0.851	0.6±1.0	0.7±1.3	0.815
Normal work	29 (61.7)	31 (83.8)	0.026	1.6±1.4	2.3±1.5	0.021	15 (57.7)	10 (58.8)	0.941	1.1±1.1	1.2±1.3	0.663	7 (53.8)	5 (45.5)	0.682	1.1±1.3	0.7±1.0	0.480
Relations with other people	35 (74.5)	27 (73.0)	0.877	2.0±1.4	1.9±1.4	0.798	20 (76.9)	13 (76.5)	0.973	1.6±1.2	1.4±1.0	0.574	7 (53.8)	6 (54.5)	0.973	1.0±1.1	0.9±0.9	0.830
Sleep	33 (70.2)	27 (73.0)	0.781	2.0±1.6	2.1±1.7	0.705	17 (65.4)	10 (58.8)	0.663	1.2±1.1	1.2±1.3	0.904	5 (38.5)	4 (36.4)	0.916	0.9±1.4	0.6±0.9	0.564
Enjoyment of life	41 (87.2)	33 (89.2)	0.784	2.7±1.6	2.9±1.5	0.671	18 (69.2)	12 (70.6)	0.925	1.7±1.4	1.6±1.4	0.880	6 (46.2)	6 (54.5)	0.682	1.0±1.2	1.4±1.5	0.509

Abbreviations: LH, laparoscopic hysterectomy; AH, abdominal hysterectomy; NRS, numerical rating scale.