Higher post-operative day 1 Pain Linked to Increased Post-Surgery Complications: Study
Researchers have found in a new study that higher pain scores on post-operative day 1 were independently associated with greater 30-day infectious and non-infectious complications. Infectious complications occurred later (average 6.5 days) than non-infectious ones (average 4.1 days). The study was published in Regional Anesthesia and Pain Medicine journal by Esmee V. H. and fellow researchers.
Postoperative pain is a familiar problem after extensive abdominal operations like cytoreductive surgery, HIPEC, esophageal surgery, liver resections, and pancreatic surgery. Although pain is anticipated, increasing evidence suggests that greater levels of pain in the early postoperative period can have physiological effects beyond patient discomfort, such as stress-induced immunosuppression. The present study sought to investigate how intensity of pain on postoperative day 1 (POD1) is associated with an increased risk of complications within 30 days after surgery.
The study group used data from 1,000 patients who were randomly chosen to undergo major abdominal surgery from 2014 to 2020 at Radboud University Medical Center. Pain scores on POD1 were retrieved from electronic patient files. The primary outcomes were complications on POD30, grouped as infectious, non-infectious, total complications, and graded using the Clavien-Dindo grading system. Statistical analysis applied logistic regression to find the correlation between early pain and complication rates.
Key Findings
Total complications: 790 complications in 572 patients occurred within 30 days post-surgery.
Infectious complications: 289 (36.7%) occurred, with average onset 6.5 days following surgery (SD 5.6).
Non-infectious complications: 501 (63.4%) occurred, with average onset 4.1 days following surgery (SD 4.7).
Pain scores and risk of complications:
Total complications: OR = 1.132 (95% CI: 1.076–1.190)
Clavien-Dindo classification: OR = 1.131 (95% CI: 1.071–1.193)
Infectious complications: OR = 1.126 (95% CI: 1.059–1.196)
Non-infectious complications: OR = 1.079 (95% CI: 1.022–1.140)
Increased postoperative pain on the first day after large abdominal surgery correlates with a greater risk of infectious and non-infectious complications in the next 30 days. This correlation underscores a rationale for specific perioperative pain management strategies to enhance recovery from surgery and surgical outcomes. Additional studies are needed to identify whether optimizing early pain control can decrease complication rates directly.
Reference:
van Helden, E., Kranendonk, J., Vermulst, A., Boer, A. de, Reuver, P. de, Rosman, C., Wilt, J. de, van Laarhoven, K., Scheffer, G. J., Keijzer, C., & Warlé, M. (2025). Early postoperative pain and 30-day complications following major abdominal surgery: a retrospective cohort study. Regional Anesthesia and Pain Medicine, 50(8), 651–657. https://doi.org/10.1136/rapm-2024-105277
