• Suzanne R Harrogate, Jackie A Cooper, Mateusz Zawadka, and Sibtain Anwar.
• Perioperative Medicine, Barts Heart Centre and St. Bartholomew's Hospital, London, UK.
• Eur J Pain. 2021 Sep 1; 25 (8): 1829-1838.

BackgroundOur aim was to describe the long-term prevalence, risk factors and impact on quality of life of persistent postsurgical pain (PPP) following cardiac surgery.MethodsAll patients undergoing sternotomy in a single centre over 6 months were prospectively interviewed by telephone at six months and seven years following surgery.ResultsWe analysed data from 174 patients at six months and 146 patients at seven years following surgery, revealing a PPP prevalence of 39.7% (n = 69) and 9.6% (n = 14) respectively. At six post-operative months, younger age, higher acute pain score, intraoperative remifentanil infusion and more prolonged surgery were associated with sternotomy-site PPP. These variables, in combination, predict PPP in this study group with area under the receiver operating curve of 0.91 (95% CI 0.86-0.94) at 6 months and 0.74 (95% CI 0.57-0.86) at 7 years. Quality of life scores were significantly lower with PPP (median change in EQ-5D score = -0.23 [-0.57, -0.09] compared to 0.00 [0-0.24] without PPP at 7 years, p < 0.001). At7 years, younger age, prolonged surgery and intraoperative remifentanil infusion were associated with sternotomy-site PPP.ConclusionsTo the best of our knowledge, this is the longest follow-up of PPP across all surgical specialities and certainly within cardiac surgery. Prevalence of PPP and impact on QOL after cardiac surgery are high and associated with young age, high acute pain score, use of remifentanil and long operative time. We present a predictive score to highlight patients at risk of developing PPP.SignificanceSeven years after cardiac surgery, almost 10% of patients in this cohort described persistent pain in and around the incision. While higher than previous reports in the literature (limited to up to five post-operative years), this assessment was made following three maximal coughs and therefore is movement or function evoked. High incident of persistent postsurgical pain may adversely affect long-term quality of life which is measured using a validated tool.© 2021 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.

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