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Preoperative frailty and its association with postsurgical pain in an older patient cohort
  1. Gary Joseph Esses1,
  2. Xiaoyu Liu2,
  3. Hung-Mo Lin2,
  4. Yury Khelemsky1 and
  5. Stacie Deiner1
  1. 1Department of Anesthesiology Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  2. 2Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Dr Gary Joseph Esses, Department of Anesthesiology Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY 10029, USA; gary.esses{at}


Background and objectives Chronic postsurgical pain in patients over 65 negatively impacts recovery, quality of life and physical functioning. In the community setting, chronic pain has been shown to be related to frailty, a syndrome more commonly seen in older adults and characterized by limited physiologic reserve and ability to withstand stressors. While frailty is an important preoperative risk factor for poor surgical outcomes in older adults, the relationship between frailty and postsurgical pain in this population has not been investigated. We hypothesized that preoperative frailty would be associated with greater odds of postsurgical chronic pain.

Methods We conducted a prospective cohort study of 116 patients older than 65 years old who underwent major elective non-cardiac surgery. Patients were assessed for frailty within 30 days prior to surgery using the FRAIL Scale assessment and pain was evaluated before surgery and at 3 months after surgery using the Geriatric Pain Measure.

Results After adjusting for baseline characteristics, we found that frail patients were almost five times more likely to have intrusive postsurgical pain compared with patients who were not frail (OR 4.73, 95% CI 1.24 to 18.09). Intrusive preoperative pain and spine surgery were also associated with increased postsurgical pain (OR 10.13, 95% CI 2.81 to 36.57 and OR 4.02, 95% CI 1.22 to 13.17, respectively).

Conclusion Although future studies are needed to establish a causal relationship between preoperative frailty and postsurgical pain, our findings suggest that older patients should have preoperative frailty assessments and frail older adults may need additional resources to improve postsurgical pain outcomes.

Trial registration number NCT02650687

  • postoperative pain
  • pain measurement
  • surgical outcome
  • pain medicine

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  • Presented at Interim data from this work were presented at the 9th World Congress of the World Institute of Pain World Institute of Pain in Dublin, Ireland, 9-12 May 2018.

  • Contributors GJE: study concept and design, data collection, writing of manuscript. XL, HML: interpretation of data, statistical analysis. YK: study concept and design, interpretation of data. SD: study coordinator, study concept and design, interpretation of data, writing of manuscript. All authors: critical review of manuscript, approval of final version.

  • Funding The study was supported in part by K23 AG17-015 National Institute on Aging and National Institutes of Health (SD), American Federation of Aging (AFAR) Beeson Scholar Program (SD), Eliasberg Research Program at Icahn School of Medicine at Mount Sinai (GJE).

  • Competing interests SD serves as a consultant for Merck and Covidien.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Icahn School of Medicine at Mount Sinai Institutional Review Board

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.