Risk factors for persistent pain after breast and thoracic surgeries: A systematic literature review and meta-analysis

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperReviewResearchpeer-review

  • Joshua Lim, Saint Louis University
  • ,
  • Dili Chen, Sydney Medical School
  • ,
  • Ewan McNicol, Massachusetts College of Pharmacy and Health Sciences
  • ,
  • Lokesh Sharma, Washington University St. Louis
  • ,
  • Grihith Varaday, Washington University St. Louis
  • ,
  • Anshuman Sharma, Washington University St. Louis
  • ,
  • Elizabeth Wilson, Washington University St. Louis
  • ,
  • Tiffany Wright-Yatsko, Washington University St. Louis
  • ,
  • Lauren Yaeger, Washington University St. Louis
  • ,
  • Ian Gilron, Queen’s University
  • ,
  • Nanna B. Finnerup
  • Simon Haroutounian, Washington University St. Louis

Persistent postsurgical pain (PPSP) is common after breast and thoracic surgeries. Understanding which risk factors consistently contribute to PPSP will allow clinicians to apply preventive strategies, as they emerge, to high-risk patients. The objective of this work was to systematically review and meta-analyze the literature on risk factors of PPSP after breast and thoracic surgeries. A systematic literature search using Ovid Medline, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and Scopus databases was conducted. Study screening with inclusion and exclusion criteria, data extraction, and risk of bias assessment was performed independently by 2 authors. The data for each surgical group were analyzed separately and meta-analyzed where possible. The literature search yielded 5584 articles, and data from 126 breast surgery and 143 thoracic surgery articles were considered for meta-analysis. In breast surgery, younger age, higher body mass index, anxiety, depression, diabetes, smoking, preoperative pain, moderate to severe acute postoperative pain, reoperation, radiotherapy, and axillary lymph node dissection were the main factors associated with higher risk of PPSP. In thoracic surgery, younger age, female sex, hypertension, preoperative pain, moderate to severe acute postoperative pain, surgical approach, major procedure, and wound complications were associated with PPSP. This systematic review demonstrated certain consistent risk factors of PPSP after breast and thoracic surgeries, as well as identified research gaps. Understanding the factors that increase susceptibility to PPSP can help selectively allocate resources to optimize perioperative care in high-risk patients and help develop targeted, risk-stratified interventions for PPSP prevention.

Original languageEnglish
Pages (from-to)3-20
Number of pages18
Publication statusPublished - Jan 2022

Bibliographical note

Publisher Copyright:
© 2021 International Association for the Study of Pain

    Research areas

  • Breast surgery, Chronic postsurgical pain, Mastectomy, Meta-analysis, Persistent postsurgical pain, Risk factors, Systematic review, Thoracic surgery, Thoracotomy

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