Abstract
Background: Renal cell carcinoma (RCC) is the most common neoplasm in kidneys, and surgical resection remains the mainstay treatment. Few studies have investigated how the postoperative pain changes over time and what has affected its trajectory. This study aimed to characterize the variations in postoperative pain over time and investigate associated factors after RCC surgery. Methods: This retrospective study was conducted in a single medical center in Taiwan, where maximal pain scores in a numeric rating scale were recorded daily in the first five postoperative days (PODs) after RCC surgery. Latent curve models were developed, using two latent variables, intercept and slope, which represented the baseline pain and rate of pain resolution. These models explain the variations in postoperative pain scores over time. A predictive model for postoperative pain trajectories was also constructed. Results: There were 861 patients with 3850 pain observations included in the analysis. Latent curve analysis identified that female patients and those with advanced cancer (stage III and IV) tended to have increased baseline pain scores (p = 0.028 and 0.012, respectively). Furthermore, patients over 60 years, without PCA use (both p < 0.001), and with more surgical blood loss (p = 0.001) tended to have slower pain resolution. The final predictive model fit the collected data acceptably (RMSEA = 0.06, CFI = 0.95). Conclusion: Latent curve analysis identified influential factors of acute pain trajectories after RCC surgery. This study may also help elucidate the complex relationships between the variations in pain intensity over time and their determinants, and guide personalized pain management after surgery for RCC.
Highlights
Introduction iationsRenal cell carcinoma (RCC) accounts for more than 90% of cancers in the kidney [1].Surgical excision through radical or partial nephrectomy remains the standard curative treatment [1]
Our analysis showed that advanced cancer and female sex are two influential factors on the baseline pain level, while age≥ 60, usage of patient-controlled analgesia (PCA), and more surgical blood loss are the other three influential factors on the rate of pain resolution
With regard to the influence of aging on postoperative pain trajectory, previous studies had shown that older patients have either lower postoperative pain intensity or slightly slower pain relief from analgesics, compared with younger patients [13,14,37]. These findings were likely attributed to various changes with aging, including greater pain tolerance, overall decline in peripheral nociceptive function, and drug distribution in the human body [38,39]. Contrasting their results, our study demonstrated that advanced age was associated with faster postoperative pain relief, but did not affect the baseline pain level
Summary
Introduction iationsRenal cell carcinoma (RCC) accounts for more than 90% of cancers in the kidney [1].Surgical excision through radical or partial nephrectomy remains the standard curative treatment [1]. Renal cell carcinoma (RCC) is the most common neoplasm in kidneys, and surgical resection remains the mainstay treatment. Methods: This retrospective study was conducted in a single medical center in Taiwan, where maximal pain scores in a numeric rating scale were recorded daily in the first five postoperative days (PODs) after RCC surgery. Latent curve models were developed, using two latent variables, intercept and slope, which represented the baseline pain and rate of pain resolution. These models explain the variations in postoperative pain scores over time. Latent curve analysis identified that female patients and those with advanced cancer (stage III and IV) tended to have increased baseline pain scores
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