Session VIII - General Interest

Sat., 10/12/13 Topics of General Interest, PAPER #91, 1:05 pm OTA 2013

Δ Impact of Early Postoperative Pain on Outcomes One Year Following Traumatic Orthopaedic Injury

Kristin R. Archer, PhD1; Sara E. Heins2; Christine M. Abraham, MA1;
William T. Obremskey, MD, MPH1; Stephen T. Wegener, PhD3; Renan C. Castillo, PhD2;
1Vanderbilt University Medical Center, Nashville, Tennessee, USA;
2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;
3Johns Hopkins Medicine, Baltimore, Maryland, USA

Purpose: The purpose of this study was to determine whether the level of pain at hospital discharge predicts physical and mental health, depression, and posttraumatic stress disorder (PTSD) at 1 year following traumatic orthopaedic injury. The hypothesis was that increased pain at discharge would predict decreased physical and mental health and increased depressive and PTSD symptoms after controlling for patient and injury characteristics.

Methods: This study prospectively enrolled 225 patients, 19 to 86 years of age, admitted to a Level I trauma center for surgical treatment of a traumatic lower extremity (87%) or upper extremity (13%) orthopaedic injury. Participants were enrolled postoperatively on the orthopaedic unit and answered questions on demographics. A discharge assessment measured pain intensity (Brief Pain Inventory [BPI]). A follow-up assessment 1 year after hospitalization measured physical and mental health (Short Form-12) and depressive and PTSD symptoms (Patient Health Questionnniare-9 [PHQ-9] and PTSD Checklist-Civilian Version [PCL-C], respectively). Clinical characteristics were abstracted from the medical record. At 1 year, 132 patients (59%) completed follow-up. Multiple imputation techniques were employed for patients lost to follow-up. However, 12 patients with both missing discharge and follow-up data were excluded from the final analysis. Separate multivariable linear regression analyses (N = 213) were performed to determine whether pain at hospital discharge predicted the outcomes of physical and mental health and depressive and PTSD symptoms, after controlling for age, gender, race, marital status, education level, employment status, and ISS. The level of significance was set at α = 0.05.

Results: Average pain intensity scores at hospital discharge on the BPI were 6.3 (standard deviation [SD], 2.4). 28% of patients reported mild pain (BPI <5), 28% moderate pain (5 ≤BPI <7), and 44% severe pain (BPI ≥7). Separate multivariable regression analyses showed that increased pain at discharge predicted decreased mental health (β = –0.91; P = 0.02), increased depressive symptoms (β = 0.58; p= 0.03), and increased PTSD symptoms (β = 1.6; P = 0.01) at 1-year follow-up. In addition, having greater than a high school education predicted increased mental health (β = 5.6; P = 0.01) and decreased depressive (β = –2.7; P = 0.01) and PTSD symptoms (β = –7.2; P = 0.01). Pain at hospital discharge was not found to be a statistically significant predictor of physical health at 1-year follow-up.

Conclusion: Results imply that efforts to improve pain assessment and management among hospitalized orthopaedic trauma patients are needed to improve long-term mental health outcomes. Early screening for unmanaged pain is encouraged in order to identify patients at high risk for poor outcomes and who could benefit from more aggressive pain management.

Alphabetical Disclosure Listing

• The FDA has not cleared this drug and/or medical device for the use described in this presentation   (i.e., the drug or medical device is being discussed for an “off label” use).  ◆FDA information not available at time of printing. Δ OTA Grant.