A survey of post‐sternotomy chronic pain following cardiac surgery

Abstract

Coronary artery bypass grafting (CABG) is a common surgical procedure with over 19 000 cases carried out in the UK in 2006/07. Persistent chest wall pain following cardiac surgery was termed Post-CABG Pain Syndrome (PCPS) in 1989 [1]. It has a reported incidence of up to 56% and is recognised as an important postoperative complication [2]. Currently PCPS is not considered in our patients’ consent procedure. We undertook a survey of 100 CABG patients in order to determine the incidence of PCPS in our population. We obtained local ethics committee approval for this structured questionnaire. One hundred consecutive CABG patients were contacted by telephone 8–10 months after their operation. Post CABG Pain Syndrome was defined using previously published criteria [1, 2]: postoperative chest pain (right, left or midline) persisting for more than 3 months. The pain was qualified in terms of its site, nature, severity, neuropathic component, need for analgesics and effect on sleep and activities of daily living. Data were analysed using Fisher’s exact test with Bonferroni correction for multiple comparisons and unpaired Student’s t-test. A separate questionnaire completed by cardiac surgeons asked about their perceived incidence of PCPS. Completed datasets were available for 79 patients; 46% patients met the criteria for a diagnosis of PCPS. Analysis revealed statistically significant higher mean pain scores on ICU (p = 0.012), the ward (p = 0.046) and on discharge (p = 0.024) in the patients with PCPS. Subgroup analysis of other previously reported risk factors for PCPS failed to reach statistical significance. The cardiac surgeons estimated the incidence of PCPS to be 0.01–5%. This study reveals a high incidence (46%) of PCPS in our population that is greatly underestimated by our cardiac surgeons. Our data show that increased postoperative pain is a risk factor for developing PCPS. This is consistent with evidence following other types of surgery [3]. Limitations of this study include selection bias and a small sample size. We conclude that PCPS is a significant when seeking patients’ consent. We intend to investigate the link between increased complication that should be included postoperative pain and PCPS further.