Anxiety and Pain Fear Before Surgery Predict Chronic Post-

Surgical Pain
Aug. 15, 2013 When post surgical pain becomes chronic pain, the causes
could be related to the type of surgery performed or from common
psychological factors considered to be predictive of chronic post-op pain, such
as anxiety, depression and pain catastrophizing. Research reported in The
Journal of Pain showed that a combination of acute pain and anxiety and pain
magnification, regardless of the type of surgical procedure, increases the risk
for development of chronic pain. The Journal of Pain is the peer-reviewed
publication of the American Pain Society.

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For the study, a team of French researchers assessed the predictive value of chronic pain risk factors
these factors in patients who had two different types of surgery: total knee arthroplasty (TKA) and breast
cancer surgery. They compared the extent to which anxiety and depression predicted the prevalence and
intensity of chronic post-operative pain three months following surgery. They hypothesized that despite
differences in the two surgical procedures, there would be common affective or cognitive risk factors for
progression to chronic post surgical pain.
For the study, patients scheduled for total TKA and mastectomy or lumpectomy filled out questionnaires a
month ahead of surgery to provide demographic information and baseline ratings of anxiety or pain
catastrophizing. On the day before surgery, patients were questioned in person about their pain status
and intensity, anxiety levels and depression. Two days after surgery, the questions focused on pain
status and patients subsequently were mailed surveys to rate their pain at three, six and 12 months
following surgery. The article reported on the data obtained after two days and at three months.
Results showed that state anxiety is predictive of clinically meaningful post surgical pain after three
months while pain magnification, an element of pain catastrophizing, predicts higher pain intensity levels.
The authors concluded that from a clinical perspective their results showed that a combination of acute
pain and anxiety and pain magnification, regardless of the type of surgical procedure, increases the risk
for development of chronic pain. They also found that half of the study subjects said they had clinically
significant pain two days after surgery, despite taking high doses of analgesics. It was recommended that
to minimize risks for developing chronic post-surgical pain clinicians should utilize optimal pain
management treatments immediately after the procedure and screen all patients scheduled for surgery
for state anxiety and pain magnification tendencies.








Hospital Readmission Rates Linked With Quality of Surgical Care
Sep. 18, 2013 Reducing hospital readmission rates is an important clinical
and policy priority but whether those rates really measure the quality of
hospital care isn't clear. In a new study, researchers from Harvard School of
Public Health (HSPH) found strong evidence of a relationship between
surgical readmission rates and quality of surgical care. The finding provides
an opportunity for policymakers to improve surgical quality and decrease
readmission costs and supports plans by the Centers for Medicare and
Medicaid Services to expand its readmission penalty program to include
surgical procedures.

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"Our findings suggest that focusing on surgical readmissions may be a smart policy approach to both
improving care and reducing unnecessary spending," said Ashish Jha, professor of health policy at HSPH
and the study's senior author.
The study appears in the Sept. 19, 2013 issue of the New England Journal of Medicine.
Much of the policy focus to date has been on reducing readmissions after hospitalization for medical
conditions, such as heart failure and pneumonia, but this approach has been controversial. Readmissions
for medical conditions are primarily driven by how sick the patients are and whether they live in poor or
better-off communities; the link between hospital quality and readmissions is less clear. The authors
postulated that surgical care may be different -- and sought to find out if there was a relationship between
readmission rates after surgery and the quality of surgical care in that hospital.
The researchers calculated 30-day readmission rates using Medicare data for six major surgical
procedures: coronary-artery bypass grafting, pulmonary lobectomy, endovascular repair of abdominal
aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement. The study
cohort was composted of 479,471 discharged patients from 3,004 hospitals in the U.S. who underwent
one of the six procedures.
The results showed that approximately one in seven patients discharged was readmitted within 30 days.
Hospitals with the best performance on two well-established measures of hospital surgical quality,
surgical volume and 30-day mortality rates, had much lower readmission rates than other hospitals. For
example, hospitals in the highest quartile for surgical volume had a significantly lower readmission rate
than hospitals in the lowest quartile (12.7% vs. 16.8%). Hospitals with the lowest surgical mortality rates
had a significantly lower readmission rate than hospitals with the highest mortality rates (13.3% vs.
14.2%).
The findings provide evidence of a strong relationship between surgical quality and readmissions and
could encourage hospitals to focus on making surgical care better. "The findings are good news for policy
makers and the public health community as a way to reduce health care spending and improve outcomes
for surgical patients," said Thomas Tsai, the lead author of the study. Tsai is a post-doctoral fellow at
HSPH and a surgical resident at Brigham and Women's Hospital.