Risk of pain and gastrointestinal

complaints at six months after

elective abdominal surgery
Abstract

■ The incidence of chronic postoperative abdominal

pain (CPAP) after abdominal surgery is substantial and
decreases overall quality of life.
■ Previous studies lack data on preoperative health and
pain status
The aim of this study is to assess risk factors for CPAP
and gastrointestinal complaints six months after
surgery.
■ A prospective cohort study was performed including
patients undergoing an elective laparotomy or
laparoscopy at a tertiary referral centre.

2
Introduction

■ The incidence of chronic postoperative abdominal

pain (CPAP) is associated with an increase of
gastrointestinal symptoms and decreases overall
quality of life
■ Intra-abdominal adhesions are deemed as the cause of
CPAP in 60% of patients.
■ Risk factors associated with CPAP are female gender,
lower age, preoperative anxiety and depression.
Other types of surgery associated with a high incidence
of chronic post-op pain, are amputations, thoracic
surgery, breast surgery, and groin hernia surgery

3
Methods

Study Design and Patients

Patients younger
than 18 years or
patients

Mental disorder
LAPAD
Minor Surgeries
Patients didn't
Major
complete the pre
Abdominal and post-op GSRS
Surgery Patients died within 6
months after surgery

Assessed before, during, Excluded

Include and after hospital stay
until 6 months

4
Methods

Variables

5
Methods

Variables
■ The duration of preoperative pain
■ Usage of analgesia
■ The GSRS questionnaire
■ The SF-36

The primary outcome of this study is the presence of abdominal

pain six months postoperatively (chronic abdominal pain) and
was defined as no abdominal pain or abdominal pain interfering
with social activities.

The secondary outcome is the total postoperative GSRS score.

6
Study Pathway

7
Results

Baseline Characteristic
■ The indication for surgery was a malignancy in 47%, a ventral
hernia in 19% or other indications in 27%
■ The anatomical location of surgery was the lower gastrointestinal
tract in 221 (43%), the hepato-biliary-pancreatic tract in 94 (18%)
and the abdominal wall in 90 (17%) patients.
■ Median (interquartile range) hospital stay was 7 (5 – 11) days, and
was not significantly different between subgroups based on
anatomical location.
■ Pre-operatively, 165 (33%) patients had abdominal pain of whom
129 (26%) patients reported a NRS score of 4 or higher. 412 (80%)
patients did not use analgesia, whereas 48 (9%) used opioid
analgesia preoperatively. 144 (28%) patients had abdominal pain
more than 3 months before surgery, 118 of whom had prior
abdominal surgery (81.9%)
8
 Abdominal pain and complaints 6 months after surgery

■ Six months after surgery, 184 (36%) patients had abdominal pain
impairing social functioning.
■ The median GSRS score was 5 (table 3).
■ The most commonly reported symptoms were borborygmus by
310 (60%) patients, abdominal distension by 242 (57%),
eructation by 260 (50%) patients and increased flatulence by 339
(65%) patients. 123 (24%) patients reported to have fecal
incontinence impacting social functioning.
■ Only 33 patients (6%) had no gastrointestinal complaints six
months after surgery.

9
Risk factors for abdominal pain six months after surgery

■ Pre-op mental health subscale SF-36

■ Indications of surgery
■ Number of previous abdominal surgery
>3
■ Presence of pain in time
■ Anatomical location of surgery
■ Creation of a colostomy

10
Discussion

■ Over one third of patients reported having chronic postoperative

pain impacting social functioning and almost every patient had
gastro-intestinal symptoms at six months after elective
abdominal surgery.
■ Factors associated with a lower risk of chronic pain were higher
age, a higher BMI, preoperative mental health and using a midline
incision.
■ 90% patients had any kind of gastrointestinal complaint six
months after surgery and patients noted to have almost two
times more often borborygmus, abdominal distension, eructation
and increased flatulence impacting social functioning in
comparison to abdominal pain

11
Conclusion

One in three patients will have chronic

postoperative abdominal pain six months after elective
abdominal surgery and 9 out of 10 patients
gastrointestinal complaints.
The duration and severity of preoperative pain,
more severe acute postoperative pain and the presence of
anxious and depressive symptoms were the most relevant
risk factors whereas adhesions and adhesiolysis related
problems were not evident as risk factor for CPAP.
The number of operations and the anatomical
location of the operation showed to be important risk
factors for increasing the number of gastrointestinal
complaints.
12
Thank You, any
question?