Clinical Factors and Pre- Surgery Depression Scores Predict Pain Intensity in Cardiac Surgery Patients - The 68th Annual Conference of the Israel Heart Society in association with the Israel Society of Cardiothoracic Surgery

Noa Caspi Avissar ¹ , Dina Granot ¹ Liza Grosman-Rimon ¹ Jacob Gohari ² Mattan Arazi ⁴ Sagi Gleitman ¹ Jawdat Badarny ¹ Alla Lubovich ^1,2,3 Shemy Carasso ^1,3 Edo Birati ^1,3 Erez Kachel ^1,3,4

¹Division of Cardiovascular Medicine and Surgery, Poriya Medical Center, Israel
²The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Israel
³The Azrieli Faculty of Medicine,, Bar-Ilan University, Israel
⁴Department of Cardiac Surgery, Sheba Medical Centre, Israel

Objectives: Moderate to severe pain is prevalent in cardiac surgery patients and can increase cardiac complications, morbidity and mortality. The objectives of the study were to assess perioperative pain intensity and to assess predictors of pain post-cardiac surgery, including clinical characteristics and depression.

Methods: A total of 98 cardiac surgery patients were included in the study. Pain intensity was assessed using a Numerical Rating System at 1 day pre-operatively and 2 day post-operatively until hospital discharge. Clinical data were recorded and depression scores were assessed using the Center for Epidemiological Study of Depression (CES-D).

Results: Pain intensity increased significantly during hospitalization from pre-operative levels, surging at 2 day post-operatively. Predictors of high pain intensity were high pre-operative CES-D scores, female gender, cardiac function, smoking and high BMI. Significantly higher pre-operative CES-D scores were found in patients with severe pain compared to patients with no pain to moderate pain (18.23±1.80 vs 12.84±1.22, p= 0.01 pre-operatively). Patients with severe pain (NRS 7-10) had significantly higher levels of white blood cells (WBC) compared to patients with no pain-moderate pain (NRS 0-6), (p=0.01). However, CES-D scores were only weakly correlated maximum WBC levels perioperatively.

Discussion: Pain intensity significantly increased following surgery, and was associated with depressive symptoms, female sex, cardiac function, BMI, and smoking. These factors may serve as a basis for identification and intervention to help prevent the transition from acute pain to chronic pain.