Incidence and risk factors of persistent postoperative pain after cardiac surgery: a systematic review and meta-analysis.

Abstract

Background: Persistent postoperative pain after cardiac surgery (PPPCS) is a prevalent complication. This paper aims to appraise the incidence of PPPCS and analyze its related risk factors through systematic evaluation and Meta-analysis.

Methods: According to PRISMA guidelines, two researchers independently searched seven databases (PubMed, Cochrane Library, Web of Science, Scopus, China National Knowledge Infrastructure, Wanfang Database and China Biomedical Database) until October 5, 2024. Finally, 40 eligible studies were included. The quality of the included articles was evaluated by Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality Agency Scale. The random-effect model was selected for Meta-analysis. Meta-regression analysis was conducted to test whether the publication time affected the incidence of PPPCS.

Results: The incidence of PPPCS changed at different times after operation: 31.7% (27.2%, 36.2%) at 3 to 6 months, 25.1% (19.5%, 30.7%) at 6 to 12 months, 24.4% (18.1%, 30.7%) at 12 to 24 months, and 13.1% (7.6%, 18.6%) at more than 24 months. Meta-regression revealed that longer postoperative follow-up (12-24 months and beyond 24 months) was associated with a lower overall incidence of PPPCS.Significant risk factors included females, age < 69 years old, BMI≥28 kg/m², poor wound healing, intraoperative remifentanil infusion, chronic pain history, and moderate-severe pain (day 0-5).

Conclusion: The incidence of PPPCS ranged from 13.1% to 31.7%. Female sex, younger age, elevated BMI, poor wound healing, intraoperative remifentanil use, history of chronic pain, and severe acute postoperative pain were associated with higher odds of PPPCS. However, given the observational nature of the included studies, variable confounder adjustment, small numbers of studies for certain risk factors, and high heterogeneity, these associations should be interpreted cautiously and require confirmation in prospective studies with standardized definitions and more comprehensive adjustment. The identified factors may guide risk stratification but should not yet be regarded as definitively established causal determinants of PPPCS.