50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Persistent Post-Surgical Pain Following Outpatient Total Joint Replacement Surgery: A Retrospective Study

Authors: Tanuj Mahendru, BS, Alice Yu, BS, Katrina Brakoniecki, MD, Daniel Witmer, MD, Sanjay Sinha, MD

OBJECTIVES: This retrospective study aimed to evaluate the incidence of persistent post-surgical pain (PPSP) in patients undergoing outpatient total joint replacement and identify risk factors for its development

BACKGROUND:

● PPSP after total joint replacement (TJR) surgery occurs in 10–20% of patients

● Most data comes from inpatient populations who have higher risk factors for development of PPSP

● TJR is increasingly being performed in outpatient settings in free- standing ambulatory surgery centers

● Outpatient surgery patients may have lower risk for PPSP due to better health profiles

● The incidence of PPSP in outpatient TJR patients is not well documented

METHODS:

● Data from patients who had elective TJR at a free-standing surgery center (May 2023 – April 2024)

● Pre-operative and 3-month post-surgery data collected including PROMIS-10 Global Health Short Form (Mental & Physical health T-

scores)

● Persistent post-surgical pain defined as pain score ≥5 on a 0-10 scale

DATA ANALYSIS:

● Incidence of PPSP analyzed with Pearson Chi-Square

● Associations with pre-op and 3-month mental/physical health T-scores analyzed using logistic regression

RESULTS:

● 754 patients, 601 with complete data for analysis:

● Incidence of PPSP differed significantly across procedure types (Pearson Chi-Square = 13.69, p = 0.008)

● Procedure type was the only significant predictor of persistent post-surgical pain (logistic regression)

● Total hip replacement patients were less likely to report pain scores ≥5 at 3 months (B = -1.281, p = 0.035, OR = 0.28)

● There was a significant change in both physical and mental health T-scores at 3 months post-surgery

DISCUSSION:

• PPSP incidence in outpatient population similar to inpatient populations

• Screening for low comorbidity, high functional capacity, and mental illness did not reduce PPSP risk

• Incidence in partial knee replacement similar to total knee replacement, likely due to similar surgical trauma affecting the medial knee

• Significant improvement in Physical Health T-scores from pre-op to 3 months reflects recovery in physical functioning, consistent with surgery goals

• Mental Health T-scores showed significant but modest improvement suggests mental health recovery influenced by factors beyond surgery

• Total hip replacement patients had significantly lower risk of PPSP, in line with clinical observations

FUTURE DIRECTIONS:

● Findings highlight the need for continued psychosocial support to improve surgical outcomes

● Further studies needed to confirm findings and explore strategies to reduce PPSP after outpatient TJR

● Longitudinal studies important to assess long-term impact of PPSP on quality of life and healthcare use

● Investigate cost-effectiveness of integrated

● Psychosocial care models for broader implementation

● Future studies should focus on developing standardized care pathways for consistent patient support

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

PERSISTENT POST-SURGICAL PAIN FOLLOWING OUTPATIENT TOTAL JOINT REPLACEMENT SURGERY: A RETROSPECTIVE STUDY

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