Risk factors for persistent post-surgical pain after tibia fracture: a longitudinal study
Journal Title: Hong Kong Journal of Orthopaedic Research - Year 2018, Vol 1, Issue 1
Abstract
Background: Although persistent post-surgical pain after tibia fracture is common, its predictors have received limited study. Purposes: We used data collected as part of the Trial to Re-evaluate Ultrasound in the Treatment of Tibial Fractures (TRUST) to address, among patients with a tibial shaft fracture, the association between baseline characteristics and persistent pain up to 12 months post-operatively. Patients and Methods: Patients were adults with an open or closed tibial fracture enrolled in TRUST at 43 participating centers across Canada and the United States between October 2008 and September 2012. We defined our study outcome, the resolution of troublesome pain, as no more than mild persistent pain (pain score ≤3 on a 0-10 Numeric Rating Scale) at two consecutive follow-up visits. We used a multivariable Cox proportional hazards regression model for analysis. Results: We included 481 patients with open or closed fractures of the tibia who underwent surgical repair. During the 12-month follow-up period, 313 of 481 (65.1%) participants reported resolution of troublesome pain. We found significant independent associations between resolution of troublesome pain and male sex (hazard ratio [HR]=1.34 [95% confidence interval (CI), 1.04 to 1.72]), non-smoking (HR=1.74 [95% CI, 1.33 to 2.29]) and alcohol consumption (HR=1.35 [95% CI, 1.06 to 1.73]). Age, obesity, type of fracture (closed versus open), additional injuries, and post-operative weight-bearing status did not predict resolution of troublesome pain. Conclusions: In our study, non-medical factors were predictive of persistent troublesome pain after tibial fracture repair, whereas injury severity was not. Results of the study will alert clinicians of the higher risk of persistent post-operative troublesome pain in female smokers who do not use alcohol, and allow them to use this information as a means to counsel female smokers to discontinue smoking. Further prospective studies are needed to confirm or refute the findings in our study.
Authors and Affiliations
Yaping Chang, Jason W Busse, Mohit Bhandari, Wei Qi, Li Wang, Diane Heels-Ansdell, Qi Zhou, Lehana Thabane, Mei Wang, Kan Lun Zhu, Brad Petrisor, Lin Jin, Sean Alexander Kennedy, Sheila Sprague, Paula McKay, Nicole Simunovic, Shiyun Hu, Yuan Zhang, Ying Zhang, Gordon H. Guyatt
Keywords
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