Predictors of persistent postoperative pain after surgery for idiopathic scoliosis

Anastasios Charalampidis; Lina Rundberg; Hans Möller; Paul Gerdhem

doi:10.1302/1863-2548.15.210090

Predictors of persistent postoperative pain after surgery for idiopathic scoliosis

J Child Orthop. 2021 Oct 1;15(5):458-463. doi: 10.1302/1863-2548.15.210090.

Authors

Anastasios Charalampidis^{1

2}, Lina Rundberg³, Hans Möller^{1

4}, Paul Gerdhem^{1

2}

Affiliations

¹ Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Sweden.
² Department of Reconstructive Orthopaedics, Karolinska University Hospital, Stockholm, Sweden.
³ Department of Surgery, Danderyd Hospital, Stockholm, Sweden.
⁴ Stockholm Center for Spine Surgery, Stockholm, Sweden.

Abstract

Purpose: To identify factors contributing to persistent postoperative pain in patients treated surgically for idiopathic scoliosis.

Methods: In total, 280 patients aged ten through 25 years at surgery, were identified in the Swedish Spine registry; all having preoperative and postoperative visual analogue scale (VAS) for back pain scores. The patients were divided into a high and low postoperative pain group based on the reported postoperative VAS for back pain scores (by using 45 mm on the 0 mm to 100 mm VAS scale as a cut-off). The patient-reported questionnaire included VAS for back pain, the 3-level version of EuroQol 5-dimensional (EQ-5D-3L) instrument, the EuroQol VAS (EQ-VAS) and the Scoliosis Research Society 22r instrument (SRS-22r). Predictors of postoperative back pain were searched in the preoperative data.

Results: The 67 (24%) patients that reported high postoperative VAS back pain (> 45 mm) also reported lower postoperative EQ-5D-3L, EQ-VAS and SRS-22r than patients with low postoperative VAS back pain (all p < 0.001). Two preoperative variables were independently associated with postoperative pain; each millimetre increase in preoperative VAS back pain (on the 0 mm to 100 mm scale) was associated with a higher risk of being in the high postoperative back pain group (odds ratio (OR) 1.03; 95% confidence interval (CI) 1.02 to 1.05) and each 1 point decrease on the preoperative SRS-22r mental health (scale from 1 to 5) was associated with a higher risk of being in the high postoperative back pain group (OR 1.68; 95% CI 1.03 to 2.73).

Conclusion: High preoperative back pain and low preoperative mental health are independent predictors of back pain after surgery for idiopathic scoliosis.

Level of evidence: III.

Keywords: idiopathic scoliosis; patient reported outcome measures; predictors of postoperative pain; quality of life.