Examination of Nurse-Modifiable Risk Factors for Chronic Post-Surgical Pain after Cardiac Surgery
Bibliographic record
Abstract
Background: Thousands of Canadians undergo cardiac surgery each year with the aim of relieving symptoms (e.g., angina) and improving health-related-quality-of-life (HRQoL). Despite the demonstrated symptom-related benefits of these surgeries, evidence suggests that the development of chronic post-surgical pain (CPSP) is a major clinical problem. To date, several perioperative factors have been examined for their potential to confer risk for CPSP. Purpose: The purpose of the study was to explore the association between preoperative moderate to severe anxiety and depressive symptoms; moderate to severe acute postoperative pain; and cumulative opioid dose consumption with the development of CPSP at six months and 12 months after cardiac surgery. Method: Design. This thesis was a prospective observational cohort sub-study of adults undergoing cardiac surgery in a tertiary care hospital setting (n=735), recruited from Hamilton Health Sciences, Canada over a five year period. Measures. The independent variables included state anxiety, depressive symptoms, acute postoperative pain intensity, and opioid dose consumption. At baseline, the Spielberger State-Trait Anxiety Inventory (STAI) assessed state anxiety and the Hospital Anxiety and Depression Scale (HADS) assessed depressive symptoms. The Brief Pain Inventory-Short Form (BPI-SF) assessed acute postoperative pain intensity on postoperative days three (in-hospital) and 30 (at home via telephone). All instruments have established reliability and validity in cardiac surgery patients (e.g., STAI Cronbach’s alpha (α) =0.82; HADS α=0.81; BPI-SF α=0.87). Medical records were reviewed and total dose of opioids consumed up to three days postoperatively, were collected via analgesic chart audit and converted into milligrams of parenteral morphine equivalent dose using standard dosage tables. Dependent variable. The primary outcome of CPSP was assessed dichotomously (i.e., yes/no) at six months and 12 months after cardiac surgery. If present, CPSP was assessed via the BPI-SF. At baseline, data was collected on pre-specified model covariates (e.g., age, sex). Data Analyses. Logistic regression was used to model the primary outcome with the presence of CPSP at six months and 12 months, while adjusting for model covariates. Secondary linear regression models were constructed to examine the effect of the independent variables on the severity of CPSP with statistical significance set at p-values <0.05. Results: The incidence of CPSP was 8.7% at six months and 4.1% at 12 months after cardiac surgery. Baseline demographics (i.e., age, sex) and medical status (i.e., diabetes mellitus) were significantly associated with the presence of CPSP. Moderate to severe preoperative anxiety was not significantly associated with CPSP at six months (adjusted OR 0.629, 95% CI [0.300, 1.322], p=0.222) or 12 months (adjusted OR 0.743, 95% CI [0.242, 2.285], p=0.604). Moderate to severe preoperative depressive symptom was not significantly associated with CPSP at six months (adjusted OR 0.676, 95% CI [0.152, 3.005], p=0.607) or 12 months (adjusted OR 3.216, 95% CI [0.835, 12.382], p=0.089). Acute postoperative pain rated as pain ‘right now’ on day three was significantly associated with CPSP at six months (adjusted OR 2.263, 95% CI [1.255, 4.081], p=0.007) and 12 months (adjusted OR 2.749, 95% CI [1.174, 6.441], p=0.020). Acute postoperative pain ‘right now’ on day 30 was significantly associated with CPSP at six months (adjusted OR 2.913, 95% CI [1.304, 6.505], p=0.009). Cumulative opioid dose consumed was significantly associated with the development of CPSP at six months (adjusted OR 1.001, 95% CI [1.000, 1.002], p=0.003) and 12 months (adjusted OR 1.001, 95% CI [1.000, 1.001], p=0.033) after cardiac surgery. Significance: The findings demonstrate that acute postoperative pain ‘right now’ and cumulative opioid dose consumed are risk factors for CPSP after cardiac surgery. These findings offer targets for nursing staff to identify potentially at-risk patients, implement evidence-based pain management strategies, as well as contribute to nursing-led research designed to target CPSP after cardiac surgery.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".