Table 4.
Demographic and clinical data of 257 women without pelvic pain undergoing hysterectomy in relation to de novo pelvic pain one year post-surgery
| De novo pelvic pain | Logistic regression * | |||||
| Yes (n=16) | No (n=241) | Univariate OR (95% CI) | Multivariable † aOR (95% CI) | p-value | ||
| Preoperative variables | ||||||
| Age (years) | 45.8 (7.8) | 47.4 (5.3) | 0.95 (0.87-1.04) | 0.97 (0.88-1.06) | 0.47 | |
| Body mass index (kg/m2) | 27.5 (5.0) | 26.8 (4.5) | 1.03 (0.93-1.15) | 1.03 (0.92-1.16) | 0.59 | |
| Parous | 12 (75.0) | 211 (87.6) | 0.38 (0.12-1.28) | 0.30 (0.08-1.14) | 0.08 | |
| Missing data | 0 (0.0) | 3 (1.2) | ||||
| Smoking | 2 (12.5) | 20 (8.3) | 1.54 (0.33-7.24) | 1.50 (0.30-7.53) | 0.63 | |
| Missing data | 0 (0.0) | 6 (2.5) | ||||
| ASA physical status classification I | I | 7 (43.8) | 155 (64.3) | 1.00 (reference) | 1.00 (reference) | |
| II-III | 9 (56.2) | 86 (35.7) | 2.32 (0.83-6.44) | 2.90 (0.92-9.09) | 0.07 | |
| Comorbidity | Cardiovascular | 3 (18.9) | 41 (17.0) | 1.13 (0.31-4.13) | 1.31 (0.31-5.55) | 0.72 |
| Pulmonary | 4 (25.0) | 23 (9.5) | 3.16 (0.94-10.60) | 2.89 (0.79-10.54) | 0.12 | |
| Medication | Analgesics | 2 (12.5) | 35 (14.5) | 0.84 (0.28-3.86) | 0.68 (0.13-3.39) | 0.63 |
| Anti-depressives or sedatives | 5 (31.3) | 33 (13.7) | 2.87 (0.94-8.77) | 1.68 (0.46-6.16) | 0.43 | |
| Hypnotics | 1 (6.3) | 12 (5.0) | 1.27 (0.15-10.75) | 0.44 (0.04-4.72) | 0.49 | |
| Physical workload | Sedentary | 4 (25.0) | 65 (27.0) | 1.00 (reference) | 1.00 (reference) | |
| Medium | 4 (25.0) | 72 (29.9) | 0.90 (0.22-3.76) | 0.92 (0.21-4.10) | 0.91 | |
| Heavy | 8 (50.0) | 94 (39.0) | 1.38 (0.40-4.78) | 1.30 (0.35-4.78) | 0.70 | |
| Missing data | 0 (0.0) | 10 (4.1) | ||||
| Gainfully employed | 15 (93.8) | 226 (93.8) | 1.00 (0.12-8.05) | 3.20 (0.28-37.16) | 0.35 | |
| Previous laparotomy | 2 (12.5) | 83 (34.4)) | 0.27 (0.06-1.19) | 0.24 (0.05-1.13) | 0.07 | |
| Missing data | 0 (0.0) | 4 (1.7) | ||||
| Indication for hysterectomy | Bleeding disorder | 7 (43.8) | 52 (21.6) | 1.00 (reference) | 1.00 (reference) | |
| Myoma | 5 (31.2) | 119 (49.4) | 0.31 (0.09-1.03) | 0.25 (0.65-0.93) | 0.04 | |
| Myoma and bleeding | 1 (6.2) | 32 (13.3) | 0.23 (0.03-1.98) | 0.20 (0.02-1.91) | 0.16 | |
| Cervical dysplasia | 2 (12.5) | 30 (12.4) | 0.50 (0.10-2.54) | 0.60 (0.11-3.28) | 0.55 | |
| Pain | 1 (6.3) | 6 (2.5) | 1.24 (0.13-11.86) | 0.93 (0.08-10.52) | 0.96 | |
| Other | 0 (0.0) | 2 (0.8) | NA | NA | ||
| Number of pain areas on body-mapping | 9.8 (5.6) | 4.4 (6.0) | 1.09 (1.03-1.16) | 1.15 (1.05-1.27) | <0.01 | |
| How often did you have pain preoperatively | No pain | 0 (0.0) | 68 (28.2) | p=0.06‡ | NA | |
| Rarely | 2 (12.5) | 15 (6.2) | 2.17 (0.36-12.95) | 2.54 (0.38-16.95) | 0.34 | |
| Sometimes | 4 (25.0) | 65 (27.0) | 1.00 (reference) | 1.00 (reference) | ||
| Often | 3 (18.7) | 51 (21.2) | 0.96 (0.20-4.46) | 0.91 (0.17-4.83) | 0.91 | |
| Almost always/ always | 5 (31.3) | 33 (13.7) | 2.46 (0.62-9.79) | 2.59 (0.53-12.63) | 0.24 | |
| Missing data | 2 (12.5) | 9 (3.7) | ||||
| Average intensity of preoperative pain (VAS scale 1-10) | (n =14) 4.6 (2.8) | (n = 6) 2.9 (2.6) | 1.27 (1.04-1.55) | 1.28 (1.01-1.62) | 0.04 | |
| Regional pain areas | Head | 6 (37.5) | 60 (24.9) | 1.81 (0.64-5.19) | 1.59 (0.50-5.01) | 0.43 |
| Neck and shoulder | 11 (68.8) | 72 (29.9) | 5.16 (1.73-15.40) | 4.66 (1.46-14.87) | <0.01 | |
| Chest | 1 (6.3) | 8 (3.3) | 1.94 (0.23-16.56) | 1.65 (0.17-16.26) | 0.67 | |
| Abdomen | 6 (37.5) | 67 (27.8) | 1.56 (0.54-4.46) | 1.39 (0.46-4.21) | 0.57 | |
| Thoracic back | 3 (18.8) | 19 (7.9) | 2.70 (0.71-10.30) | 2.88 (0.66-12.58) | 0.16 | |
| Lower back | 11 (68.8) | 79 (32.8) | 4.51 (1.52-13.43) | 4.24 (1.37-13.17) | 0.01 | |
| Upper extremities | 6 (37.5) | 39 (16.2) | 3.11 (1.07-9.05) | 4.24 (1.18-15.30) | 0.03 | |
| Lower extremities | 9 (56.3) | 54 (22.4) | 4.45 (1.58-12.51) | 5.23 (1.63-16.79) | <0.01 | |
| HADS-A score | 7.3 (4.9) | 4.7 (4.0) | 1.15 (1.03-1.29) | 1.10 (0.93-1.29) | 0.27 | |
| HADS-A (in categories) | Normal | 7 (43.8) | 190 (78.8) | 1.00 (reference) | 1.00 (reference) | |
| Borderline abnormal | 4 (25.0) | 27 (11.2) | 4.02 (1.10-14.65 | 4.94 (1.20-20.28) | 0.03 | |
| Abnormal | 5 (21.2) | 24 (10.0) | 5.65 (1.66-19.22) | 10.61 (1.84-61.03) | <0.01 | |
| HADS-D score | 4.3 (3.1) | 2.4 (3.1) | 1.16 (1.02-1.31) | 1.06 (0.88-1.29) | 0.53 | |
| HADS-D (in categories) | Normal | 14 (87.5) | 217 (90.1) | 1.00 (reference) | 1.00 (reference) | |
| Borderline abnormal | 1 (6.2) | 16 (6.6) | 0.97 (0.12-7.84) | 0.25 (0.02-3.11) | 0.28 | |
| Abnormal | 1 (6.2) | 8 (3.3) | 1.94 (0.23-16.60) | 0.54 (0.04-7.15) | 0.64 | |
| SCI score | 177.8 (32.5) | 185.6 (26.7) | 0.99 (0.97-1.01) | 1.01 (0.98-1.03) | 0.56 | |
| SCI (in categories) | Low stress coping | 7 (43.8) | 63 (26.1) | 2.20 (0.79-6.15) | 0.95 (0.25-3.63) | 0.94 |
| High stress coping | 9 (56.2) | 178 (73.9) | 1.00 (reference) | 1.00 (reference) | ||
| SF-36 PCS | 44.8 (13.7) | 49.8 (8.1) | 0.94 (0.90-0.99) | 0.95 (0.89-1.00) | 0.06 | |
| SF-36 MCS | 42.7 (10.9) | 48.2 (10.1) | 0.96 (0.92-0.99) | 0.99 (0.93-1.06) | 0.79 | |
| EQ-5D-3L health index | 0.63 (0.26) | 0.84 (0.18) | 0.03 (0.00-0.19) | 0.02 (0.00-0.32) | <0.01 | |
| Heat pain threshold (ºC) | (n = 14) 47.7 (2.1) | (n = 213) 47.6 (2.5) | 1.01 (0.81-1.26) | 1.06 (0.83-1.37) | 0.62 | |
| Cold pain threshold (ºC) | (n = 14) 3.4 (6.3) | (n = 213) 2.9 (5.6) | 1.01 (0.93-1.11) | 1.01 (0.92-1.12) | 0.78 | |
| Pressure pain threshold (kPa) | (n = 14) 470 (188) | (n = 212) 517 (199) | 1.00 (1.00-1.00) | 1.00 (1.00-1.00) | 0.41 | |
| Intra- and postoperative variables | ||||||
| Mode of hysterectomy | Total abdominal | 10 (62.5) | 169 (70.1) | 1.00 (reference) | 1.00 (reference) | |
| Subtotal abdominal | 2 (12.5) | 21 (8.7) | 1.61 (0.33-7.85) | 1.51 (0.28-8.24) | 0.63 | |
| Vaginal | 4 (25.0) | 51 (21.2) | 1.33 (0.40-4.41) | 1.06 (0.30-3.77) | 0.93 | |
| Mode of anesthesia | GA | 8 (50.0) | 86 (35.7) | 1.00 (reference) | 1.00 (reference) | |
| SA + IM | 4 (25.0) | 83 (34.4) | 0.52 (0.15-1.79) | 0.60 (0.16-2.28) | 0.46 | |
| GA + IM | 4 (25.0) | 72 (29.9) | 0.60 (0.17-2.06) | 0.67 (0.18-2.47) | 0.54 | |
| Incision in abdominal wall** | Low transverse | 12 (75.0) | 169 (71.3) | 1.00 (reference) | 1.00 (reference) | |
| Midline | 0 (0.0) | 17 (7.2) | p=0.60‡ | NA | ||
| Operation time (minutes) | 89.6 (33.4) | 91.6 (41.9) | 1.00 (0.99-1.01) | 1.00 (0.98-1.01) | 0.89 | |
| Estimated bleeding intraoperatively (mL) | 157 (162) | 182 (250) | 1.00 (1.00-1.00) | 1.00 (1.00-1.00) | 0.67 | |
| Uterus weight (gram) | 387 (456) | 384 (377) | 1.00 (1.00-1.00) | 1.00 (1.00-1.00) | 0.88 | |
| Blood transfusion (no. of women) | 1 (6.2) | 10 (4.1) | 1.54 (0.18-12.84) | 2.12 (0.16-28.30) | 0.57 | |
| Duration of hospital stay (days) | 2.3 (0.9) | 1.7 (0.9) | 1.40 (0.98-1.99) | 1.50 (1.02-2.21) | 0.04 | |
| Maximum pain intensity day 0 § (scale 0-6) | (n=16) 3.4 (1.4) | (n=237) 3.2 (1.7) | 1.08 (0.80-1.46) | 1.03 (0.74-1.42) | 0.79 | |
| Maximum pain intensity day 1 § (scale 0-6) | (n=16) 3.6 (1.2) | (n=238) 3.00 (1.4) | 1.33 (0.92-1.94) | 1.36 (0.89-2.06 | 0.15 | |
| Classification of surgical complications | C-D grade 0 | 12 (74.0) | 179 (74.3) | 1.00 (reference) | 1.00 (reference) | |
| C-D grade I | 1 (6.2) | 22 (9.1) | 0.67 (0.08-5.41) | 0.63 (0.07-5.59) | 0.68 | |
| C-D grades II-III | 3 (18.8) | 40 (16.6) | 1.11 (0.30-4.10) | 1.03 (0.27-3.98) | 0.97 | |
aOR adjusted odds ratio, C-D Clavien-Dindo classification of postoperative complications, CI confidence interval, EQ-5D-3L Euroqol form-five dimensions-three levels, GA general anesthesia, HADS-A Hospital Anxiety and Depression Scale- Anxiety, HADS-D Hospital Anxiety and Depression Scale- Depression, IM intrathecal morphine, MCS, mental component summary, NA not applicable, PCS physical component summary, SA spinal anesthesia, SCI Stress Coping Inventory, SF-36 Short Form 36 items
*Missing data not included in the analyses
† Adjusted for age, Body mass index, smoking, preoperative use of analgesics, mode of hysterectomy, postoperative complications (Clavien-Dindo), HADS-A, and HADS-D
**Includes abdominal hysterectomies only
‡ Because of a cell with no observations, the logistic regression could not be calculated. Instead, the p-value of Fisher’s exact test or Pearson chi-square test is given, as appropriate
§ Day 0 and day 1 indicate day of surgery and the day after surgery, respectively