Table 1.
Preoperative demographic and clinical data of 440 women undergoing hysterectomy, categorized by patient-reported pain spread
| Patient-reported pain areas preoperatively | |||||||
|
All (N=440) |
No pain areas (n=79) |
Pelvis only (n=31) |
Pelvis and other areas (n=152) |
Non-pelvic areas only (n=178) |
p-value† | ||
| Preoperative variables | |||||||
| Age (years) | 46.5 (5.5) | 47.6 (5.4) | 46.5 (4.5) | 45.3 (5.4) | 47.2 (5.6) | <0.01 # | |
| Body mass index (kg/m2) | 26.9 (4.6) | 26.3 (4.7) | 26.8 (4.3) | 26.9 (4.9) | 27.0 (4.4) | 0.71 # | |
| Parous | 381 (6.6) | 71 (89.9) | 30 (96.8) | 128 (84.2) | 152 (85.4) | 0.23 | |
| Missing data | 3 (0.7) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3 (1.7) | ||
| Smoking | 45 (10.2) | 3 (3.8) | 3 (9.7) | 20 (13.2) | 19 (10.7) | 0.17 | |
| Missing data | 10 (2.3) | 3 (3.8) | 0 (0.0) | 4 (2.6) | 3 (1.7) | ||
| ASA physical status classification | Class I | 285 (64.8) | 53 (67.1) | 19 (61.3) | 104 (68.4) | 109 (61.2) | 0.63 |
| Class II | 143 (32.5) | 25 (31.6) | 12 (38.7) | 43 (28.3) | 63 (35.4) | ||
| Class III | 12 (2.7) | 1 (1.3) | 0 (0.0) | 5 (3.3) | 6 (3.4) | ||
| Comorbidity | Cardiovascular | 66 (15.0) | 17 (21.5) | 3 (9.7) | 19 (12.5) | 27 (15.2 | 0.25 |
| Pulmonary | 41 (9.3) | 6 (7.6) | 0 (0.0) | 14 (9.2) | 21 (11.8) | 0.19 | |
| Medication | Analgesics | 77 (17.5) | 4 (5.1) | 0 (0.0) | 40 (26.3) | 33 (18.5) | <0.0001 |
| Anti-depressives or sedatives | 62 (14.1) | 5 (6.3) | 3 (9.7) | 21 (13.8) | 33 (18.5) | 0.06 | |
| Hypnotics | 19 (14.3) | 4 (5.1) | 0 (0.0) | 6 (3.9) | 9 (5.0) | 0.62 | |
| Physical workload | Sedentary | 119 (27.0) | 22 (27.8) | 11 (35.5) | 39 (27.7) | 47 (26.4) | 0.16 |
| Medium | 122 (27.7) | 32 (40.5) | 5 (16.1) | 41 (27.0) | 44 (24.7) | ||
| Heavy | 178 (40.5) | 25 (31.7) | 14 (45.2) | 62 (40.8) | 77 (43.3) | ||
| Missing data | 21 (4.8) | 0 (0.0) | 1 (3.2) | 10 (6.6) | 10 (5.6) | ||
| Gainfully employed | 412 (93.6) | 77 (97.5) | 31 (100.0) | 140 (92.1) | 164 (92.1) | 0.15 | |
| Previous laparotomy | 150 (34.1) | 29 (36.7) | 9 (29.0) | 56 (36.8) | 56 (31.5) | 0.71 | |
| Missing data | 4 (0.9) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 4 (2.2) | ||
| Indication for hysterectomy | Bleeding disorder | 109 (24.8) | 15 (19.0) | 7 (22.6) | 43 (28.3) | 44 (24.7) | 0.08 |
| Myoma | 203 (46.1) | 40 (50.6) | 17 (54.8) | 62 (40.8) | 84 (47.2) | ||
| Myoma and bleeding | 53 (12.0) | 10 (12.7) | 4 (12.9) | 16 (10.5) | 23 (12.9) | ||
| Cervical dysplasia | 46 (10.5) | 12 (15.2) | 1 (3.2) | 13 (8.6) | 20 (11.2) | ||
| Pain | 27 (6.1) | 1 (1.3) | 2 (6.4) | 18 (11.8) | 6 (3.4) | ||
| Others | 2 (0.5) | 1 (1.3) | 0 (0.0) | 0 (0.0) | 1 (0.6) | ||
| Number of pain areas on body-mapping | 5.7 (6.7) | NA | 1.0 (--) | 8.2 (7.5) | 6.9 (6.2) | <0.01* | |
| How often do you have pain | No pain | 68 (15.5) | 68 (86.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | <0.0001 |
| Rarely | 33 (7.5) | 4 (5.1) | 1 (3.2) | 15 (9.9) | 13 (7.3) | ||
| Sometimes | 136 (30.9) | 1 (1.3) | 20 (64.5) | 47 (30.9) | 68 (38.2) | ||
| Often | 111 (25.2) | 0 (0.0) | 6 (19.4) | 51 (33.5) | 54 (30.3) | ||
| Almost always/ always | 74 (16.8) | 0 (0.0) | 0 (0.0) | 36 (23.7) | 38 (21.4) | ||
| Missing data | 18 (4.1) | 6 (7.6) | 4 (12.9) | 3 (2.0) | 5 (2.8) | ||
| Average intensity of preoperative pain (VAS scale 1-10) |
(N = 428) 3.8 (2.6) |
(n = 79) NA |
(n = 27) 3.9 (2.1) |
(n = 152) 5.0 (2.0) |
(n = 170) 4.4 (2.0) |
<0.01 # | |
| HADS-A score | 4.9 (4.0) | 3.9 (3.7) | 3.2 (3.2) | 5.4 (4.1) | 5.5 (4.1) | <0.01 # | |
| HADS-A (in categories) | Normal | 323 (73.4) | 66 (83.6) | 26 (83.9) | 100 (65.8) | 131 (73.6) | 0.04 |
| Borderline abnormal | 68 (15.5) | 8 (10.1) | 4 (12.9) | 33 (21.7) | 23 (12.9) | ||
| Abnormal | 49 (11.1) | 5 (6.3) | 1 (3.2) | 19 (12.5) | 24 (13.5) | ||
| HADS-D score | 2.6 (3.0) | 1.7 (2.3) | 1.4 (1.9) | 3.0 (3.0) | 2.9 (3.4) | <0.001 # | |
| HADS-D (in categories) | Normal | 400 (90.9) | 76 (96.2) | 31 (100.0) | 138 (90.8) | 155 (87.1) | 0.13 |
| Borderline abnormal | 28 (6.4) | 2 (2.5) | 0 (0.0) | 11 (7.2) | 15 (8.4) | ||
| Abnormal | 12 (2.7) | 1 (1.3) | 0 (0.0) | 3 (2.0) | 8 (4.5) | ||
| SCI score | 185.4 (25.5) | 186.4 (26.3) | 193.4 (21.4) | 184.2 (23.1) | 184.5 (27.5) | 0.33 # | |
| SCI (in categories) | Low stress coping | 109 (24.8) | 15 (19.0) | 5 (16.1) | 34 (22.4) | 55 (30.9) | 0.08 |
| High stress coping | 331 (75.2) | 64 (81.0) | 26 (83.9) | 118 (77.6) | 123 (69.1) | ||
| SF-36 PCS score | 47.9 (9.3) | 53.5 (5.5) | 50.5 (6.7) | 44.7 (10.0) | 47.7 (9.1) | <0.0001 # | |
| SF-36 MCS score | 47.6 (10.3) | 50.4 (7.7) | 50.7 (8.7) | 36.6 (10.5) | 46.7 (11.0) | <0.01 # | |
| EQ-5D-3L health index | 0.80 (0.20) | 0.90 (0.18) | 0.84 (0.18) | 0.74 (0.21) | 0.80 (0.19) | <0.0001 # | |
| Heat pain threshold (ºC) |
(N = 370) 47.5 (2.6) |
(n=69) 47.3 (2.6) |
(n=25) 48.0 (2.2) |
(n=118) 47.2 (2.9) |
(n=158) 47.7 (2.5) |
0.44 # | |
| Cold pain threshold (ºC) |
(N = 370) 3.7 (6.4) |
(n=69) 2.6 (5.1) |
(n=25) 3.4 (5.6) |
(n=118) 5.3 (7.5) |
(n=158) 3.1 (5.9) |
0.02 # | |
| Pressure pain threshold (kPa) |
(N = 367) 503 (199) |
(n=69) 515 (220) |
(n=25) 530 (225) |
(n=116) 476 (193) |
(n=158) 513 (189) |
0.40 # | |
| Intra- and postoperative variables | |||||||
| Mode of hysterectomy | Total abdominal hysterectomy | 310 (70.4) | 58 (73.4) | 22 (71.0) | 109 (71.7) | 121 (68.0) | 0.86 |
| Subtotal abdominal hysterectomy | 35 (8.0) | 7 (8.9) | 1 (3.2) | 11 (7.2) | 16 (9.0) | ||
| Vaginal hysterectomy | 95 (21.6) | 14 (17.7) | 8 (25.8) | 32 (21.1) | 41 (23.0) | ||
| Mode of anesthesia | General anesthesia (GA) | 162 (36.8) | 30 (38.0) | 9 (29.0) | 59 (38.2) | 64 (36.0) | 0.14 |
| Spinal anesthesia + intrathecal morphine | 164 (37.3) | 30 (38.0) | 17 (54.9) | 60 (39.5) | 57 (32.0) | ||
| Intrathecal morphine + GA | 114 (25.9) | 19 (24.0) | 5 (16.1) | 33 (21.7) | 57 (32.0) | ||
| Incision in abdominal wall | No abdominal incision | 95 (21.6) | 14 (17.7) | 8 (25.8) | 32 (21.0) | 41 (23.0) | 0.63 |
| Low transverse | 313 (71.1) | 58 (73.4) | 22 (71.0) | 110 (72.4) | 123 (69.1) | ||
| Midline | 25 (5.7) | 7 (8.9) | 0 (0.0) | 8 (5.3) | 10 (5.6) | ||
| Missing data | 7 (1.6) | 0 (0.0) | 1 (3.2) | 2 (1.3) | 4 (2.3) | ||
| Operation time (minutes) | 91 (48) | 93 (45) | 100 (114) | 89 (36) | 91 (39) | 0.83 # | |
| Estimated bleeding intraoperatively (mL) | 177 (218) | 184 (225) | 138 (131) | 178 (180) | 180 (255) | 0.44 # | |
| Uterus weight (gram) | 366 (346) | 412 (408) | 344 (255) | 339 (295) | 373 (370) | 0.88 # | |
| Blood transfusion (no. of women) | 15 (3.4) | 2 (2.5) | 1 (3.2) | 3 (2.0) | 9 (5.1) | 0.46 | |
| Duration of hospital stay (days) | 1.8 (1.1) | 1.6 (0.8) | 1.6 (1.8) | 1.8 (1.2) | 1.8 (1.0) | 0.02 # | |
| Maximum pain intensity day 0 § (scale 0-6) |
(n=432) 3.3 (1.7) |
(n=77) 3.1 (1.8) |
(n=31) 2.9 (1.8) |
(n=148) 3.6 (1.6) |
(n=176) 3.3 (1.7) |
0.07# | |
| Maximum pain intensity day 1 § (scale 0-6) |
(n=432) 3.3 (1.4) |
(n=78) 2.8 (1.4) |
(n=31) 3.4 (1.4) |
(n=148) 3.6 (1.4) |
(n=176) 3.2 (1.4) |
<0.001# | |
| Classification of surgical complications | C-D grade 0 | 316 (71.8) | 61 (77.2) | 23 (74.2) | 102 (67.1) | 130 (73.0) | 0.82 |
| C-D grade I | 46 (10.5) | 5 (6.3) | 4 (12.9) | 19 (12.5) | 18 (10.1) | ||
| C-D grade II | 64 (14.5) | 10 (12.7) | 4 (12.9) | 26 (17.1) | 24 (13.5) | ||
| C-D grade III | 14 (3.2) | 3 (3.8) | 0 (0.0) | 5 (3.3) | 6 (3.4) | ||
Figures denote mean and (standard deviation), or number and (percent)
ASA American Society of Anesthesiologists, C-D Contracted Clavien-Dindo classification of postoperative complications within six weeks, EQ-5D-3L European Quality of Life 5 Dimensions 3 Level version, HADS-A Hospital Anxiety and Depression Scale – Anxiety, HADS-D Hospital Anxiety and Depression Scale – Depression, SCI Stress Coping Inventory
† Continuous data are analyzed by means of non-parametric tests and nominal data by means of Pearson’s chi-squared tests. Missing data are excluded in the statistical analyses
# Kruskal-Wallis analysis of variance
* Mann-Whitney U-test for comparison between ‘Pelvis and other areas’and ‘Non-pelvic areas only’
§ Day 0 and day 1 indicate day of surgery and the day after surgery, respectively