G Model
JINJ-5754; No. of Pages 5 Injury, Int. J. Care Injured xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery Kristina Radinovic a,*, Zoka Milan b, Ljiljana Markovic-Denic c, Emilija Dubljanin-Raspopovic d,e, Bojan Jovanovic a,e, Vesna Bumbasirevic a,e a
Centre for Anaesthesiology, Clinical Centre of Serbia, Belgrade, Serbia King’s College Hospital, London, United Kingdom University of Belgrade, Faculty of Medicine, Institute of Epidemiology, Belgrade, Serbia d Clinic for Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Belgrade, Serbia e University of Belgrade, Faculty of Medicine, Belgrade, Serbia b c
A R T I C L E I N F O
A B S T R A C T
Article history: Accepted 18 May 2014
Introduction: The aim of this study was to identify risk factors for severe postoperative pain immediately after hip-fracture surgery. Patients and methods: Three hundred forty-four elderly patients with an acute hip fracture were admitted to the hospital during a 12-months period. All patients who entered the study answered a structured questionnaire to assess demographic characteristics, previous diseases, drug use, previous surgery, and level of education. Physical status was assessed through the American Society of Anesthesiologists’ preoperative risk classification, cognitive status using the Short Portable Mental Status Questionnaire, and depression using the Geriatric Depression Scale. The presence of preoperative delirium using the Confusion Assessment Method was assessed during day and night shifts until surgery. Pain was measured using a numeric rating scale (NRS). An NRS 7 one hour after surgery indicated severe pain. Results: Patients with elementary-level education (8 yr in school) presented a higher risk for immediate severe postoperative pain than university-educated patients (>12 yr in school) (P < 0.05). Higher cognitive function was associated with higher postoperative pain (P < 0.01). Patients with symptoms of depression and patients with preoperative delirium presented a higher risk for severe pain (P < 0.05, P < 0.01, respectively). Multivariate analysis showed that depression and a low level of education were independent predictors of severe pain immediately after surgery. Conclusion: Depression and lower levels of education were independent predictors of immediate severe pain following hip-fracture surgery. These predictors could be clinically used to stratify analgesic risk in elderly patients for more aggressive pain treatment immediately after surgery. ß 2014 Elsevier Ltd. All rights reserved.
Keywords: Hip fracture Immediate postoperative pain Predictors
Introduction Postoperative pain is a subjective and multifaceted experience that is influenced not only by the type of surgery and postoperative analgesia, but also by physiological, sociocultural, cognitive, and behavioural factors and age. Ineffective control of pain after surgery causes patient distress, sleep disturbance, and mood disorders, and has adverse effects on the endocrine and immune functions, which can affect wound healing and provoke
* Corresponding author at: Centre for Anaesthesiology, Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia. Tel.: +381 643343217. E-mail addresses: [email protected], [email protected] (K. Radinovic).
cardiopulmonary and thromboembolic complications [1,2]. It has been reported that pain following hip-fracture surgery is moderate to intense in 20–70% of patients [3,4], indicating that it is still undermanaged in a substantial number of patients. Inadequate control of this pain might worsen the outcome after hip fracture, limit early physiotherapy, and prolong hospital stay; however, very few studies have analyzed the importance of severe pain during the immediate postoperative period, which might also result in increased sympathetic activity and increased levels of stress hormones [5,6]. Therefore, recognizing the predictors for early, severe postoperative pain in patients with hip fractures might contribute to determining the immediate postoperative pain strategy and potentially reduce the incidence of endocrine, cardiopulmonary, and thromboembolic complications.
http://dx.doi.org/10.1016/j.injury.2014.05.024 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Radinovic K, et al. Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.05.024
G Model
JINJ-5754; No. of Pages 5 2
K. Radinovic et al. / Injury, Int. J. Care Injured xxx (2014) xxx–xxx
The majority of hip-fracture patients are elderly. Careful medical approaches, both anaesthetic and pain management, are required, as changes associated with old age such as physiological changes, co-morbidities, decreased functional reserve, and mental decline or advanced dementia could complicate early recovery after hip-fracture surgery [7]. However, older patients have often been excluded from analysis of postoperative pain management because of vision and hearing impairment, decreased cognitive function, psychiatric comorbidities, and other factors that could potentially compromise pain assessment [8]. Thus, factors that affect postoperative pain in the elderly, especially early after anaesthesia, are poorly defined [8]. The aim of this study was to identify risk factors, other than type of postoperative analgesia, for severe postoperative pain immediately after hip-fracture surgery in the elderly.
Patients and methods This prospective cohort study was carried out at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, which is a tertiary-care university hospital. The study was performed during a 1-yr period from September 2010 to September 2011. All adult patients 60 yr with an acute hip fracture were screened for potential enrolment in the study. Exclusion criteria were: age 100 min) [6]. As hip-fracture surgery time rarely exceeds 100 min (median was 92.5 min), and patients in our study were operated on by the experienced surgical team, we tested only the different anaesthetic techniques on the outcome of immediate severe postoperative pain. Finally, there are two aspects of our study related to the low resource setting, which may affect the applicability of these findings to all centres. The preoperative pain management protocol is more conservative and different from postoperative pain management for this type of surgery in developed countries. We can argue that postoperative pain control in this patient population is very challenging due to already-mentioned factors and that neither of the currently available analgesia methods is ideal for this patient population [25]. Additionally, the mean time-to-surgery period of up to 7 days was long and caused by either patient’s specific medical conditions (for example pharmacological clearance of anti-platelets drugs) and medical instability, which requires optimal medical stabiliza-
Please cite this article in press as: Radinovic K, et al. Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.05.024
G Model
JINJ-5754; No. of Pages 5 K. Radinovic et al. / Injury, Int. J. Care Injured xxx (2014) xxx–xxx
tion and treatment prior to surgery, or, more commonly, limited availability of staff, operative rooms, and system inefficacy. We compensated for it by initiating early preoperative mobilization in all our patients waiting for surgery in order to minimize the negative effects of prolonged inactivity and by rigorously using conventional preoperative pain management protocol. Postoperative pain management in this patient population is a very complex issue affected by many confounders that may be difficult to measure. For example, different nations have different attitudes towards coping to pain, and therefore no study related to pain treatment can be universally applied to all geographic areas. This study was designed to identify factors associated with increased pain in patients 1 h after having undergone surgical management of a hip fracture. This is a very important field of the study in which relatively little research has been done previously. The strength of our study is that we performed a prospective analysis on a homogenous population such as hip-fracture patients. The exclusion of patients with severe cognitive impairment contributes to the validity of pain measurement in our cohort. Moreover, we used reliable, valid, and sophisticated tools for defining the variables that were analyzed in our research. The results of our study might provide clinical guidelines for preoperative selection of patients in need of more intensive management for depression and prevention of delirium, which could decrease the incidence of severe pain immediately after hipfracture surgery. Conclusions In summary, predictors identified in our study of immediate severe postoperative pain after hip-fracture surgery are lower levels of education, higher cognitive function, depression, and the presence of preoperative delirium. These variables are easy to address on admission to the hospital and might serve to stratify hip-fracture patients at risk for severe pain who could benefit from more-aggressive pain treatment in the early phase after recovery from anaesthesia. Moreover, some of these variables are accessible to medical intervention and might be useful in creating specific preventive intervention. Furthermore, this study opens up the possibility of further investigation in pain management concerning the role of immediate postoperative pain in predicting short-and long-term rehabilitation after hip fracture Conflict of interest The authors state that they have no conflict of interest. Acknowledgment This work was supported by Ministry of Science and Technological Development of Serbia, Contract no. 175046, 2011–2014.
5
References [1] Chiu YH, Silman AJ, Macfarlane GJ, Ray D, Gupta A, Dickens C, et al. Poor sleep and depression are independently associated with a reduced pain threshold. Results of a population based study. Pain 2005;115:316–21. [2] Peters ML, Sommer M, de Riljke JM, Kessels F, Heineman E, Patijn J, et al. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 2007;245:487–94. [3] Tufano R, Puntillo F, Draisci G, Pasetto A, Pietropaoli P, Pinto G, et al. Italian Observational Study of the management of mild-to-moderate Post-Operative Pain (ITOSPOP). Minerva Anestesiol 2012;78:15–25. [4] Apfelbaum JL, Chen C, Mehta SS, Gin TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534–40. [5] Aubrun F, Valade N, Coriat P, Riou B. Predictive factors of severe postoperative pain in posthanesthesia care unit. Pain Med 2008;106(5):1535–41. [6] Kalkman CJ, Visser K, Moen J, Bonsei GJ, Grobbee DE, Moons KGM. Preoperative predictors of severe postoperative pain. Pain 2003;105:415–23. [7] Buecking B, Eschbach D, Koutras C, Kratz T, Balzer-Geldsetzer, Dodel R, et al. Re-admission to Level 2 unit after hip-fracture surgery – risk factors reasons and outcome. Injury 2013;44:1919–25. [8] Catananti C, Gambassi G. Pain assessment in the elderly. Surg Oncol 2010;19:140–8. [9] Owens WD, Felts JA, Spitznagel Jr EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49:239–43. [10] Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975;23:433–41. [11] Dubljanin-Raspopovic E, Markovic-DenicLj, Marinkovic J, Nedeljkovic U, Bumbasirevic M. Does early functional outcome predict 1-year mortality in elderly patients with hip fracture? Clin Orthopaed Relat Res 2013;471(8):2703–10. [12] Bjorkelund KB, Hommel A, Thorngren KG, Gustafson L, Larsson S, Lundberg D. Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiol Scand 2010;54:678–88. [13] Koehler M, Rabinowitz T, Hirdes J, et al. Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatr 2005;5:1–8. [14] Givens JL, Sanft TB, Marcantonio ER. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc 2008;56:1075–9. [15] Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. The confusion assessment method. A new method for detection of delirium. J Am Geriatr Soc 2008;56:823–30. [16] Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc 2008;56(5):823–30. [17] Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother 2009;9:745–58. [18] Edwards RR, Goble L, Kwan A, Kudel I, McGuire L, Heinberg L. Catastrophizing, pain, and social adjustment in scleroderma: relationships with educational level. Clin J Pain 2006;22:639–46. [19] Binhans M, Roudot-Thoraval F, Thomonet D, Maison P, Marty J. Impact of written information describing postoperative pain management on patient agreement with proposed treatment. Eur J Aneasthesiol 2008;25:884–90. [20] Scherder EJA. Low use of analgesics Alzheimer’s disease: possible mechanism. Psychiatry 2000;63:1–12. [21] Horgas AL, Elliot AF, Mersiske M. Pain assessment in persons with dementia: relationship between self-reported and behavioral observation. J Am Geriatr Soc 2009;57:126–32. [22] Vaurio L, Sands L, Wang Y, Mullen E, Leung J. The role of pain and medications on postoperative delirium. Anesth Analg 2006;102:267–73. [23] Del Rosario E, Esteve N, Semandez MJ, Batet C, Aguilar JL. Does femoral nerve analgesia impact the development of postoperative delirium in the elderly? A retrospective investigation. Acute Pain 2008;10:59–64. [24] De Cosmo G, Congedo E, Lai C, Primieri P, Dottarelli A, Aceto P. Preoperativepsychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia. Clin J Pain 2008;24:399–405. [25] Macintyre PM. Safety and efficacy of patient-control analgesia. Br J Anaesth 2001;87:36–46.
Please cite this article in press as: Radinovic K, et al. Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.05.024
JINJ-5754; No. of Pages 5 Injury, Int. J. Care Injured xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Injury journal homepage: www.elsevier.com/locate/injury
Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery Kristina Radinovic a,*, Zoka Milan b, Ljiljana Markovic-Denic c, Emilija Dubljanin-Raspopovic d,e, Bojan Jovanovic a,e, Vesna Bumbasirevic a,e a
Centre for Anaesthesiology, Clinical Centre of Serbia, Belgrade, Serbia King’s College Hospital, London, United Kingdom University of Belgrade, Faculty of Medicine, Institute of Epidemiology, Belgrade, Serbia d Clinic for Physical Medicine and Rehabilitation, Clinical Centre of Serbia, Belgrade, Serbia e University of Belgrade, Faculty of Medicine, Belgrade, Serbia b c
A R T I C L E I N F O
A B S T R A C T
Article history: Accepted 18 May 2014
Introduction: The aim of this study was to identify risk factors for severe postoperative pain immediately after hip-fracture surgery. Patients and methods: Three hundred forty-four elderly patients with an acute hip fracture were admitted to the hospital during a 12-months period. All patients who entered the study answered a structured questionnaire to assess demographic characteristics, previous diseases, drug use, previous surgery, and level of education. Physical status was assessed through the American Society of Anesthesiologists’ preoperative risk classification, cognitive status using the Short Portable Mental Status Questionnaire, and depression using the Geriatric Depression Scale. The presence of preoperative delirium using the Confusion Assessment Method was assessed during day and night shifts until surgery. Pain was measured using a numeric rating scale (NRS). An NRS 7 one hour after surgery indicated severe pain. Results: Patients with elementary-level education (8 yr in school) presented a higher risk for immediate severe postoperative pain than university-educated patients (>12 yr in school) (P < 0.05). Higher cognitive function was associated with higher postoperative pain (P < 0.01). Patients with symptoms of depression and patients with preoperative delirium presented a higher risk for severe pain (P < 0.05, P < 0.01, respectively). Multivariate analysis showed that depression and a low level of education were independent predictors of severe pain immediately after surgery. Conclusion: Depression and lower levels of education were independent predictors of immediate severe pain following hip-fracture surgery. These predictors could be clinically used to stratify analgesic risk in elderly patients for more aggressive pain treatment immediately after surgery. ß 2014 Elsevier Ltd. All rights reserved.
Keywords: Hip fracture Immediate postoperative pain Predictors
Introduction Postoperative pain is a subjective and multifaceted experience that is influenced not only by the type of surgery and postoperative analgesia, but also by physiological, sociocultural, cognitive, and behavioural factors and age. Ineffective control of pain after surgery causes patient distress, sleep disturbance, and mood disorders, and has adverse effects on the endocrine and immune functions, which can affect wound healing and provoke
* Corresponding author at: Centre for Anaesthesiology, Clinical Centre of Serbia, Pasterova 2, 11000 Belgrade, Serbia. Tel.: +381 643343217. E-mail addresses: [email protected], [email protected] (K. Radinovic).
cardiopulmonary and thromboembolic complications [1,2]. It has been reported that pain following hip-fracture surgery is moderate to intense in 20–70% of patients [3,4], indicating that it is still undermanaged in a substantial number of patients. Inadequate control of this pain might worsen the outcome after hip fracture, limit early physiotherapy, and prolong hospital stay; however, very few studies have analyzed the importance of severe pain during the immediate postoperative period, which might also result in increased sympathetic activity and increased levels of stress hormones [5,6]. Therefore, recognizing the predictors for early, severe postoperative pain in patients with hip fractures might contribute to determining the immediate postoperative pain strategy and potentially reduce the incidence of endocrine, cardiopulmonary, and thromboembolic complications.
http://dx.doi.org/10.1016/j.injury.2014.05.024 0020–1383/ß 2014 Elsevier Ltd. All rights reserved.
Please cite this article in press as: Radinovic K, et al. Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.05.024
G Model
JINJ-5754; No. of Pages 5 2
K. Radinovic et al. / Injury, Int. J. Care Injured xxx (2014) xxx–xxx
The majority of hip-fracture patients are elderly. Careful medical approaches, both anaesthetic and pain management, are required, as changes associated with old age such as physiological changes, co-morbidities, decreased functional reserve, and mental decline or advanced dementia could complicate early recovery after hip-fracture surgery [7]. However, older patients have often been excluded from analysis of postoperative pain management because of vision and hearing impairment, decreased cognitive function, psychiatric comorbidities, and other factors that could potentially compromise pain assessment [8]. Thus, factors that affect postoperative pain in the elderly, especially early after anaesthesia, are poorly defined [8]. The aim of this study was to identify risk factors, other than type of postoperative analgesia, for severe postoperative pain immediately after hip-fracture surgery in the elderly.
Patients and methods This prospective cohort study was carried out at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Centre of Serbia, which is a tertiary-care university hospital. The study was performed during a 1-yr period from September 2010 to September 2011. All adult patients 60 yr with an acute hip fracture were screened for potential enrolment in the study. Exclusion criteria were: age 100 min) [6]. As hip-fracture surgery time rarely exceeds 100 min (median was 92.5 min), and patients in our study were operated on by the experienced surgical team, we tested only the different anaesthetic techniques on the outcome of immediate severe postoperative pain. Finally, there are two aspects of our study related to the low resource setting, which may affect the applicability of these findings to all centres. The preoperative pain management protocol is more conservative and different from postoperative pain management for this type of surgery in developed countries. We can argue that postoperative pain control in this patient population is very challenging due to already-mentioned factors and that neither of the currently available analgesia methods is ideal for this patient population [25]. Additionally, the mean time-to-surgery period of up to 7 days was long and caused by either patient’s specific medical conditions (for example pharmacological clearance of anti-platelets drugs) and medical instability, which requires optimal medical stabiliza-
Please cite this article in press as: Radinovic K, et al. Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.05.024
G Model
JINJ-5754; No. of Pages 5 K. Radinovic et al. / Injury, Int. J. Care Injured xxx (2014) xxx–xxx
tion and treatment prior to surgery, or, more commonly, limited availability of staff, operative rooms, and system inefficacy. We compensated for it by initiating early preoperative mobilization in all our patients waiting for surgery in order to minimize the negative effects of prolonged inactivity and by rigorously using conventional preoperative pain management protocol. Postoperative pain management in this patient population is a very complex issue affected by many confounders that may be difficult to measure. For example, different nations have different attitudes towards coping to pain, and therefore no study related to pain treatment can be universally applied to all geographic areas. This study was designed to identify factors associated with increased pain in patients 1 h after having undergone surgical management of a hip fracture. This is a very important field of the study in which relatively little research has been done previously. The strength of our study is that we performed a prospective analysis on a homogenous population such as hip-fracture patients. The exclusion of patients with severe cognitive impairment contributes to the validity of pain measurement in our cohort. Moreover, we used reliable, valid, and sophisticated tools for defining the variables that were analyzed in our research. The results of our study might provide clinical guidelines for preoperative selection of patients in need of more intensive management for depression and prevention of delirium, which could decrease the incidence of severe pain immediately after hipfracture surgery. Conclusions In summary, predictors identified in our study of immediate severe postoperative pain after hip-fracture surgery are lower levels of education, higher cognitive function, depression, and the presence of preoperative delirium. These variables are easy to address on admission to the hospital and might serve to stratify hip-fracture patients at risk for severe pain who could benefit from more-aggressive pain treatment in the early phase after recovery from anaesthesia. Moreover, some of these variables are accessible to medical intervention and might be useful in creating specific preventive intervention. Furthermore, this study opens up the possibility of further investigation in pain management concerning the role of immediate postoperative pain in predicting short-and long-term rehabilitation after hip fracture Conflict of interest The authors state that they have no conflict of interest. Acknowledgment This work was supported by Ministry of Science and Technological Development of Serbia, Contract no. 175046, 2011–2014.
5
References [1] Chiu YH, Silman AJ, Macfarlane GJ, Ray D, Gupta A, Dickens C, et al. Poor sleep and depression are independently associated with a reduced pain threshold. Results of a population based study. Pain 2005;115:316–21. [2] Peters ML, Sommer M, de Riljke JM, Kessels F, Heineman E, Patijn J, et al. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 2007;245:487–94. [3] Tufano R, Puntillo F, Draisci G, Pasetto A, Pietropaoli P, Pinto G, et al. Italian Observational Study of the management of mild-to-moderate Post-Operative Pain (ITOSPOP). Minerva Anestesiol 2012;78:15–25. [4] Apfelbaum JL, Chen C, Mehta SS, Gin TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg 2003;97:534–40. [5] Aubrun F, Valade N, Coriat P, Riou B. Predictive factors of severe postoperative pain in posthanesthesia care unit. Pain Med 2008;106(5):1535–41. [6] Kalkman CJ, Visser K, Moen J, Bonsei GJ, Grobbee DE, Moons KGM. Preoperative predictors of severe postoperative pain. Pain 2003;105:415–23. [7] Buecking B, Eschbach D, Koutras C, Kratz T, Balzer-Geldsetzer, Dodel R, et al. Re-admission to Level 2 unit after hip-fracture surgery – risk factors reasons and outcome. Injury 2013;44:1919–25. [8] Catananti C, Gambassi G. Pain assessment in the elderly. Surg Oncol 2010;19:140–8. [9] Owens WD, Felts JA, Spitznagel Jr EL. ASA physical status classifications: a study of consistency of ratings. Anesthesiology 1978;49:239–43. [10] Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 1975;23:433–41. [11] Dubljanin-Raspopovic E, Markovic-DenicLj, Marinkovic J, Nedeljkovic U, Bumbasirevic M. Does early functional outcome predict 1-year mortality in elderly patients with hip fracture? Clin Orthopaed Relat Res 2013;471(8):2703–10. [12] Bjorkelund KB, Hommel A, Thorngren KG, Gustafson L, Larsson S, Lundberg D. Reducing delirium in elderly patients with hip fracture: a multi-factorial intervention study. Acta Anaesthesiol Scand 2010;54:678–88. [13] Koehler M, Rabinowitz T, Hirdes J, et al. Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study. BMC Geriatr 2005;5:1–8. [14] Givens JL, Sanft TB, Marcantonio ER. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc 2008;56:1075–9. [15] Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. The confusion assessment method. A new method for detection of delirium. J Am Geriatr Soc 2008;56:823–30. [16] Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method: a systematic review of current usage. J Am Geriatr Soc 2008;56(5):823–30. [17] Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother 2009;9:745–58. [18] Edwards RR, Goble L, Kwan A, Kudel I, McGuire L, Heinberg L. Catastrophizing, pain, and social adjustment in scleroderma: relationships with educational level. Clin J Pain 2006;22:639–46. [19] Binhans M, Roudot-Thoraval F, Thomonet D, Maison P, Marty J. Impact of written information describing postoperative pain management on patient agreement with proposed treatment. Eur J Aneasthesiol 2008;25:884–90. [20] Scherder EJA. Low use of analgesics Alzheimer’s disease: possible mechanism. Psychiatry 2000;63:1–12. [21] Horgas AL, Elliot AF, Mersiske M. Pain assessment in persons with dementia: relationship between self-reported and behavioral observation. J Am Geriatr Soc 2009;57:126–32. [22] Vaurio L, Sands L, Wang Y, Mullen E, Leung J. The role of pain and medications on postoperative delirium. Anesth Analg 2006;102:267–73. [23] Del Rosario E, Esteve N, Semandez MJ, Batet C, Aguilar JL. Does femoral nerve analgesia impact the development of postoperative delirium in the elderly? A retrospective investigation. Acute Pain 2008;10:59–64. [24] De Cosmo G, Congedo E, Lai C, Primieri P, Dottarelli A, Aceto P. Preoperativepsychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia. Clin J Pain 2008;24:399–405. [25] Macintyre PM. Safety and efficacy of patient-control analgesia. Br J Anaesth 2001;87:36–46.
Please cite this article in press as: Radinovic K, et al. Predictors of severe pain in the immediate postoperative period in elderly patients following hip fracture surgery. Injury (2014), http://dx.doi.org/10.1016/j.injury.2014.05.024
