Chronic Postsurgical Pain and Persistent Opioid Use Following Surgery: The Need For A Transitional Pain Service

Figures & data

Figure 1. Costs associated with the development of chronic postsurgical pain using economic modeling data from the USA and Canada.

6000 surgeries are performed per year at the Toronto General Hospital, of which 4000 are major surgical operations. Using a conservative estimate of a 5% incidence of moderate to severe pain and an annual estimate based on data from the province of Ontario, Canada of CAD$5000 in direct heath-related costs, results in a CAD$1.0–2.6 million cost to the healthcare system. The 12.5% of patients who present to our pre-operative consult clinics with a pre-existing chronic pain condition and taking an opioid-based analgesic will leave on 100–300% more opioid medication than when they were admitted to hospital. Assuming a conservative increase in direct costs for 60% of patients (n = 300 vs 100% at n = 500) our data suggest the annual total cost for these patients would be CAD$1.5 million. The total estimated expenditure for all-cause chronic pain after major surgery is between CAD$2.5 and CAD$4.1 million from a single institution.

Table 1. Patient characteristics.

Characteristic	Opioid users for surgery-related pain, n (%)	Opioid users for other pain, n (%)	Nonopioid users, n (%)
Age (years), mean (SD)	58.89 (12.36)	61.25 (16.12)	58.51 (14.37)
Sex:	n = 19	n = 8^†	n = 173
− Male	8 (42.1)	4 (50.0)	86 (49.7)
− Female	11 (57.9)	4 (50.0)	87 (50.3)
Patients reporting chronic pain prior to surgery (total n = 51), n	9	3	39
Surgery procedure:
− Cardiac	2 (10.5)	3 (37.5)	58 (33.5)
− Ear, nose and throat	1 (5.3)	0 (00)	5 (2.9)
− General	6 (31.6)	3 (37.5)	38 (22)
− Gynecological	1 (5.3)	0 (0)	13 (7.5)
− Plastic	0 (0)	0 (0)	1 (0.6)
− Thoracic	7 (36.8)	2 (25.0)	32 (18.5)
− Urology	1 (5.3)	0 (0)	18 (10.4)
− Vascular	1 (5.3)	0 (0)	8 (4.6)
Average surgical site pain score for patients reporting pain at 3 months after surgery:	n = 19		n = 51
− <4/10 (mild)	9 (47.37)		27 (52.94)
− 4 to ≤7/10 (moderate)	9 (47.37)		21 (41.18)
− 7/10 (severe)	1 (5.26)		3 (14.29)

^†n = 8 reported opioid use for pain related to other pain conditions.

SD: Standard deviation.

Table 2. Pain disability, pain interference, and global health ratings.

Outcome	Opioid users (n = 19), mean (SD)	Nonopioid users (n = 51), mean (SD)	Significance (p-vaule)
Pain Disability Index total	23.21 (17.15)	15.06 (15.92)	0.066
Brief Pain Inventory interference:
− Enjoyment	3.00 (3.42)	1.53 (2.74)	0.066
− Relationships	3.54 (2.26)	0.90 (2.12)	0.054
− Work	4.29 (3.54)	2.22 (3.03)	0.022
− Walking	3.28 (3.41)	1.16 (2.49)	<0.01
− Mood	4.05 (3.64)	1.55 (2.85)	<0.005
− Activity	3.21 (3.51)	2.08 (2.89)	0.17
− Sleep	2.74 (3.54)	1.94 (2.94)	0.34
Global health rating	55.19 (20.21)	71.27 (20.91)	<0.001

Global health rating was measured by the EQ-5D-5L health questionnaire.

SD: Standard deviation.