Key result
Chronic post-cardiac surgery pain incurs ~CAN$207 in mean monthly costs at 6 months, declining sharply over time.
Why the study?
The use of pain-related health care resources and associated direct and indirect costs over a two-year period had not been documented in cardiac surgery patients who develop chronic post-surgical pain.
What are the pain-related health care resource utilization patterns and direct and indirect costs over 24 months among patients who develop chronic post-surgical pain after cardiac surgery?
Cohort (n=1,247)
Yes
What are the pain-related health care resource utilization patterns and direct and indirect costs over 24 months among patients who develop chronic post-surgical pain after cardiac surgery?
This prospective cohort study documents for the first time that the economic burden of chronic post-surgical pain after cardiac surgery is concentrated in a minority of patients with higher pain severity and pain catastrophizing, and decreases substantially over two years.
Answers are grounded in this paper and cite their sources.
Early post-cardiac surgery pain costs decline sharply over 24 months; extends economic observations but leaves optimal management strategies open.
OBJECTIVE: The study objective was to determine use of pain-related health care resources and associated direct and indirect costs over a two-year period in cardiac surgery patients who developed chronic post-surgical pain (CPSP). METHODS: This multicentric observational prospective study recruited patients prior to cardiac surgery; these patients completed research assistant-administered questionnaires on pain and psychological characteristics at 6, 12 and 24 months post-operatively. Patients reporting CPSP also completed a one-month pain care record (PCR) (self-report diary) at each follow-up. Data were analyzed using descriptive statistics, multivariable logistic regression models, and generalized linear models with log link and gamma family adjusting for sociodemographic and pain intensity. RESULTS: Out of 1,247 patients, 18%, 13%, and 9% reported experiencing CPSP at 6, 12, and 24 months, respectively. Between 16% and 28% of CPSP patients reported utilizing health care resources for their pain over the follow-up period. Among all CPSP patients, mean monthly pain-related costs were CAN$207 at 6 months and significantly decreased thereafter. More severe pain and greater levels of pain catastrophizing were the most consistent predictors of health care utilization and costs. DISCUSSION: Health care costs associated with early management of CPSP after cardiac surgery seem attributable to a minority of patients and decrease over time for most of them. Results are novel in that they document for the first time the economic burden of CPSP in this population of patients. Longer follow-up time that would capture severe cases of CPSP as well as examination of costs associated with other surgical populations are warranted. SUMMARY: Economic burden of chronic post-surgical pain may be substantial but few patients utilize resources. Health utilization and costs are associated with pain and psychological characteristics.
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Guertin et al. (2018) conducted a cohort in Chronic post-surgical pain (CPSP) following cardiac surgery (n=1,247). Chronic post-surgical pain (CPSP) after cardiac surgery vs. Mild CPSP (1-3 on 10-point NRS) vs moderate-to-severe CPSP (4-10 on 10-point NRS), or resource users vs non-users was evaluated on Mean monthly pain-related direct and indirect costs and health care resource utilization at 6, 12, and 24 months. Chronic post-surgical pain after cardiac surgery incurred mean monthly costs of CAN$207.26 at 6 months, decreasing to CAN$100.13 at 12 months and CAN$7.68 at 24 months.
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