Preoperative Frailty and Chronic Pain After Cardiac Surgery: A Prospective Observational Study

A Prospective Observational Study

Britta C. Arends; Leon Timmerman; Lisette M. Vernooij; Lisa Verwijmeren; Douwe H. Biesma; Eric P. A. van Dongen; Peter G. Noordzij; Heleen J Blussé van Oud-Alblas


BMC Anesthesiol. 2022;22(201) 

In This Article


Chronic pain is a well-known complication after cardiac surgery and is reported by 18 to 35% of cardiac surgery patients in the Netherlands.[1–3] Especially in older patients, chronic pain, whether or not related to surgery, has a major impact on postoperative functional outcome, including health related quality of life (HRQL).[1–5] Physical inactivity and reduced self-reliance due to chronic pain, have been associated with a greater vulnerability to stressors, social isolation, anxiety and depression.[5–11] Although preoperative anesthesiological assessment routinely includes risk stratification for cardiac or pulmonary complications, standardized screening for the risk to develop chronic pain is less common. Given the negative effects, it is essential that risk factors for chronic pain after surgery are identified in order to initiate preventive strategies.

Frailty is characterized by a limited resilience to surgical stress, and has been associated with poor postoperative outcomes.[12–14] In community-dwelling elderly, chronic pain has been related to frailty.[13] Frail patients have more pain, poorer daily functioning and less physical activity.[13] In the surgical population, frailty has been associated with chronic pain after major elective non-cardiac surgery.[15] Although frailty is considered an important risk factor for poor surgical outcomes, evidence of a relationship between frailty and chronic pain following cardiac surgery is lacking. Identification of a relation between specific preoperative frailty characteristics (domains) and postoperative chronic pain may guide interventions to improve surgical outcome. With an ageing population, the number of cardiac surgery procedures in older patients will rise in the upcoming years.[4–6] Optimizing preoperative circumstances in these patients is therefore essential to target analgesic interventions and preserve postoperative quality of life. We hypothesized that preoperative frailty domains are associated with chronic pain and worse HRQL one year after cardiac surgery in older patients.

This study therefore aimed to address whether specific frailty domains are associated with chronic pain following cardiac surgery in an older population. Additionally, the relationship of chronic pain to HRQL was evaluated..