Identification of Presurgical Risk Factors for the Development of Chronic Postsurgical Pain in Adults: A Comprehensive Umbrella Review

Beate C Sydora,1 Lindsay Jane Whelan,1,2 Benjamin Abelseth,2 Gurpreet Brar,3 Sumera Idris,3 Rachel Zhao,4 Ashley Jane Leonard,4 Brittany N Rosenbloom,5 Hance Clarke,6 Joel Katz,6,7 Sanjay Beesoon,1 Nivez Rasic2,8 1Department of Surgery Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada; 2Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; 3Health Systems Knowledge and Evaluation, Alberta Health Services, Edmonton, AB, Canada; 4Knowledge Resource Service, Alberta Health Services, Edmonton, AB, Canada; 5Toronto Academic Pain Medicine Institute, Toronto, ON, Canada; 6Department of Anesthesia and Pain Management, Toronto General Hospital, UHN, Toronto, ON, Canada; 7Department of Psychology, York University, Toronto, ON, Canada; 8Department of Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB, CanadaCorrespondence: Nivez Rasic, Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Medical Lead, Vi Riddell Pain & Rehabilitation Program, Acute Pain Lead, Alberta Pain Strategy, Alberta Children’s Hospital, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada, Tel +403-955-7810, Email Nivez.Rasic@albertahealthservices.ca Sanjay Beesoon, Assistant Scientific Director, Surgery Strategic Clinical Network, Alberta Health Services, 02-048 South Tower, Seventh Street Plaza, 10030 107 St NW, Edmonton, AB, T5J 3E4, Canada, Tel +780-735-1682 ; +780-218-4786, Email Sanjay.Beesoon@albertahealthservices.caPurpose: Risk factors for the development of chronic postsurgical pain (CPSP) have been reported in primary studies and an increasing number of reviews. The objective of this umbrella review was to compile and understand the published presurgical risk factors associated with the development of CPSP for various surgery types.Methods: Six databases were searched from January 2000 to June 2023 to identify meta-analyses, scoping studies, and systematic reviews investigating presurgical CPSP predictors in adult patients. Articles were screened by title/abstract and subsequently by full text by two independent reviewers. The selected papers were appraised for their scientific quality and validity. Data were extracted and descriptively analyzed.Results: Of the 2344 retrieved articles, 36 reviews were selected for in-depth scrutiny. The number of primary studies in these reviews ranged from 4 to 317. The surgery types assessed were arthroplasty (n = 13), spine surgery (n = 8), breast surgery (n = 4), shoulder surgery (n = 2), thoracic surgery (n = 2), and carpal tunnel syndrome (n = 1). One review included a range of orthopedic surgeries; six reviews included a variety of surgeries. A total of 39 presurgical risk factors were identified, some of which shared the same defining tool. Risk factors were themed into six broad categories: psychological, pain-related, health-related, social/lifestyle-related, demographic, and genetic. The strength of evidence for risk factors was inconsistent across different reviews and, in some cases, conflicting. A consistently high level of evidence was found for preoperative pain, depression, anxiety, and pain catastrophizing.Conclusion: This umbrella review identified a large number of presurgical risk factors which have been suggested to be associated with the development of CPSP after various surgeries. The identification of presurgical risk factors is crucial for the development of screening tools to predict CPSP. Our findings will aid in designing screening tools to better identify patients at risk of developing CPSP and inform strategies for prevention and treatment.Plain Language Summary: Chronic postsurgical pain (CPSP) is pain experienced predominantly at the surgical site for longer than 3 months after a surgical procedure. Depending on surgery type, it can affect between 10 and 80% of people undergoing major surgeries, which may have negative effects such as a lower quality of life, disability, and persistent opioid use. Targeted identification and management of at risk patients in the presurgical phase may decrease the risk of CPSP. This umbrella review generated a list of potential risk factors for CPSP from evidence-based reviews of the current literature.Thirty-nine presurgical risk factors were identified in this review. Risk factors are divided into six broad categories: psychological, pain-related, health-related, demographic, genetic, and social/lifestyle-related. Although the strength of evidence for individual risk factors varied across reviews, risk factors in the psychological category consistently showed a strong impact on the development of CPSP.It is vital to understand which individuals are vulnerable and at risk for CPSP. The findings of this umbrella review will aid in designing screening tools to identify surgical candidates at risk. Some risk factors, such as genetics, cannot be altered. However, many identified risk factors are modifiable and may inform strategies for the prevention and treatment of CPSP using screening tools. Our findings may guide future research to consider an in-depth analysis of risk factor characterization to group modifiable presurgical risk factors. At risk patients will be offered psychological, physical, and pharmacological treatments accordingly to mitigate their risk of developing CPSP and ultimately improve patient outcomes in surgery.Keywords: chronic postsurgical pain, risk factors, predictors, umbrella review, surgery