Chronic Pain, Quality of Life and Functional Impairment After Emergency Laparotomy

BACKGROUND: Emergency laparotomy is a high-risk procedure with increased morbidity and mortality rates. The long-term outcomes are poorly investigated.The aim was to describe the frequency of chronic postsurgical pain (CPSP), pain-related functional impairment, to evaluate the gastrointestinal quality of life (QoL) and identify risk factors for CPSP after emergency laparotomy.

METHOD: A questionnaire study was conducted from Copenhagen University Hospital Herlev. Population area: 435.000. Patients undergoing emergency midline laparotomy from May 2009-May 2013 and June 2014-November 2015 were included. The survey consisted of five parts exploring the extent of acute and chronic postsurgical pain. Pain-related functional impairment and quality of life were measured using the activity assessment scale and the gastrointestinal quality of life questionnaire, respectively. Primary outcomes were rates of CPSP and pain-related functional impairment. Gastrointestinal QoL was compared between patients with or without CPSP. Multivariate regression analysis was performed to estimate risk factors for CPSP.

RESULTS: The primary emergency laparotomy population consisted of 1573 patients. A total of 605 patients were eligible for inclusion, and 440 patients completed the survey. Response rate: 73%. Median age was 69 years (range 18-95), 56.4% female. Median follow-up was 60 months (IQR 47). 19% (85/440) experienced CPSP and had low gastrointestinal QoL. We identified APSP OR 5.0 95%CI (2.4-10.5), p < 0.01 and age < 60 OR 2.1 95%CI (1.2-3.8), p = 0.01 as independent risk factors for CPSP. 45% (199/440) of all patients experienced moderate-severe functional impairment.

CONCLUSION: CPSP (19%) and low gastrointestinal QoL were common after emergency laparotomy and almost every second patient had moderate-severe functional impairment on long-term follow-up.