# Preoperative predictive factors associated with severe postdischarge pain after ambulatory gynaecological laparoscopy: a prospective cohort study

## TL;DR

This study identifies preoperative factors linked to severe pain after gynaecological laparoscopy, helping doctors better manage post-surgery pain in at-risk patients.

## Contribution

The study identifies four preoperative factors independently associated with severe postdischarge pain after ambulatory gynaecological laparoscopy.

## Key findings

- Younger age, preoperative pain, preoperative opioid use, and expecting severe postoperative pain are linked to severe postdischarge pain.
- 42.4% of patients experienced severe pain after discharge, with 2.3% requiring hospital admission.
- Standardized pain management did not fully prevent postdischarge pain, highlighting the need for individualized approaches.

## Abstract

Ambulatory surgery patients are at risk of postoperative pain despite modern multimodal pain regimens, and these patients are particularly vulnerable to postdischarge pain due to limited access to medical support. This study explored 24 previously suggested preoperative predictive factors with the primary aim to determine which factors are associated with severe postdischarge pain in women undergoing ambulatory gynaecological laparoscopy with standardised anaesthesia and multimodal pain prophylaxis and treatment.

In this observational prospective single-centre cohort study, women undergoing ambulatory gynaecological laparoscopy were enrolled. All patients received TIVA (propofol/remifentanil) and multimodal pain prophylaxis including paracetamol, nonsteroidal anti-inflammatory drugs, glucocorticoids, and local anaesthesia. Data were collected before surgery, upon discharge from the PACU, and on postoperative day 1. Univariable and multivariable logistic regression analyses were conducted.

In the final analyses, 439 patients were included. Four preoperative predictive factors were independently associated with severe postdischarge pain (odds ratio, 95% confidence interval): younger age: 0.95, 0.92–0.97, P<0.001; preoperative pain: 2.53, 1.58–4.05, P<0.001; preoperative opioid use: 1.89, 1.12–3.20, P=0.018; and expecting severe postoperative pain: 1.20, 1.07–1.33, P=0.001. Severe pain was experienced by 20.7% of the patients during PACU stay and by 42.4% after discharge. Severe pain resulted in hospital admission in 2.3% of the patients and need of health care contact in 3.9%.

Postdischarge pain remains a significant problem after ambulatory gynaecological laparoscopies despite adherence to guidelines for analgesic management. Preoperative predictive factors for severe postdischarge pain were younger age, preoperative pain, use of opioids before surgery and expecting severe postoperative pain. Preoperative identification of at-risk patients may allow for individualised pain prophylaxis and treatment.

NCT05050708.