Waiting for healthcare has been identified as a common experience for today’s patients [
Pain has been identified as a predominant symptom frequently experienced by patients awaiting gynaecological surgery [
Although pain [
This was a single centre cross-sectional study of women waiting for a gynaecological surgical procedure. Data for this study were collected as part of a prospective study on the development of chronic postsurgical pain in women undergoing gynaecological procedures [
All participants were English-speaking women aged 18 years or older waiting to undergo gynaecological surgery. Patients were excluded if they were diagnosed with Alzheimer’s disease or another form of cognitive impairment such as dementia or a neurological disorder.
The Theory of Unpleasant Symptoms was used to guide the methodology for the prospective study and it also applies to the current study. The theory illustrates the interplay between situational, psychological, and physiological factors and their effect on the experience of symptoms [
The independent variables were waiting time (situational), depression and anxiety (psychological), gynaecological diagnosis (physiological), and pain (physical symptom). As pain is often a major component of HCU, the primary dependent variable for this study was pain-related HCU. Covariates included demographic, surgical, and gynaecological factors.
Data collection consisted of 5 self-completed questionnaires capturing information on pain, psychological factors, and HCU. Additional clinical data on smoking status, body mass index (BMI), and registration with a family practitioner were gathered from reviewing the patient record.
Potential covariates included demographic and clinical variables that are potentially or known to be associated with the primary outcome of HCU. Age was examined as a continuous variable and categorized according to the documented menopausal range of 45–55 years [
The participants enrolled in this study all had a period of waiting time for surgery and these data were obtained from administrative data captured by the hospital. “Wait 2” is defined as the time between the decision to treat and the date of surgery. For this analysis the “adjusted days waited” was used as it adjusts for any time individuals may not have been available for surgery (e.g., vacation).
Trait anxiety was measured using the State Trait Anxiety Inventory (STAI), a self-report measurement tool of 20 questions asking about general feelings. The ranges of scores were 20–80 with a higher score indicating a greater degree of anxiety. The STAI was used by Carr et al. to examine anxiety in women prior to and following gynaecological surgery [
Depression was measured using the Centre for Epidemiologic Studies-Depression (CES-D) Scale, a 20-item questionnaire designed to study depression in the general population. It involves self-reporting of feelings during the past week. The scoring for depression was the total out of 60 possible points, with a higher score indicating a greater degree of depression. This tool has been used extensively to study chronic pain and depression [
A variable consisting of both trait anxiety and depression was also created, due to the high coexistence of anxiety and depression. Individuals were classified as having no depression (<16/60) or anxiety (<45/80) or as having one or both.
Self-reported menstrual status was classified into no longer menstruating due to natural or surgical means or not stopped/unsure. An assumption was made that if they were unsure about their periods stopping, some recent bleeding had probably occurred, and these participants were assigned to the “not stopped/unsure” category. Data regarding hormone replacement therapy (HRT) and oral contraceptives were collected as possible factors related to hormones and the pain experience; in each case, the participants were grouped according to whether they reported taking the medication or not. Lastly, self-reported preoperative malignancy status was classified as possibly malignant, malignant, or not malignant. While a confirmed diagnosis was available from hospital administrative data postoperatively, we felt the preoperative self-reported status was most relevant to HCU while waiting for surgery.
The Brief Pain Inventory Long Form (BPI-LF), a multidimensional assessment instrument, measures the severity of pain and the impact of pain on daily function [
Pain-related HCU was captured using questions adapted from the Canadian National Population Health Survey. Individuals were asked to report on the number of visits to a family doctor, specialist, walk-in clinic, emergency department (ED), or other healthcare professional “because of pain” in the past 12 months.
Descriptive statistics were calculated using frequency and percentage for categorical variables and mean, standard deviation, range, and interquartile range for continuous variables. Bivariate analysis was conducted to examine factors associated with HCU using the Chi square statistical test for categorical variables and
Of the 932 participants approached and invited to join the study, 696 (74.7%) agreed to participate and 590 (63.3%) completed the questionnaires. Sixty-eight percent (67.8%) of the participants were scheduled for a hysterectomy and 23.6% were scheduled for other uterine, tubal, or ovarian procedures. The remaining 8.6% were scheduled for exploratory, vulvar, or pelvic floor procedures. Of the 590 participants, 360 (61.3%) reported a total of 2026 healthcare visits to a family doctor, specialist, ED, or walk-in clinic for pain in the previous 12 months (Figure
Number of healthcare visits for pain during 12 months prior to surgery. Number of participants with no visits in previous year: family doctor = 283, specialist = 317, walk-in clinic = 548, and emergency = 468. Number of participants with more than 10 visits in previous year (included in the group with 10 visits): family doctor = 15, specialist = 3, and walk-in clinic = 2.
Situational, psychological, physiological, pain, clinical, and demographic characteristics for the total sample (
Baseline characteristics of women waiting for gynaecological surgery.
Total ( | |
---|---|
Demographic covariates | |
Age |
|
Years (mean (SD)) | 48.3 (11.3) |
Age |
|
18–44 years | 227 (38.9) |
45–55 years | 213 (36.5) |
≥56 years | 144 (24.7) |
Marital status |
|
Single/divorced/widowed | 167 (28.4) |
Married | 422 (71.6) |
Racial heritage |
|
Caucasian | 540 (92.9) |
Non-Caucasian | 41 (7.1) |
Highest education grade achieved‡ | |
No diploma | 69 (11.7) |
High school diploma | 118 (20.0) |
Trade or professional school certificate/diploma | 221 (37.5) |
Some university/postgraduate | 181 (30.7) |
Employment status |
|
Unemployed/retired/homemaker | 155 (26.4) |
Employed part time or full time | 384 (65.3) |
Other | 49 (8.3) |
|
|
Clinical covariates | |
Body mass index (kg/m2) |
|
Underweight/normal (≤24.9) | 155 (26.5) |
Overweight (25–29.9) | 175 (30.0) |
Obese (≥30) | 254 (43.5) |
Current smoker |
|
Yes | 123 (20.9) |
No | 466 (79.1) |
Previous abdominal surgery |
|
Yes | 404 (69.2) |
No | 180 (30.8) |
|
|
Situational factors | |
Adjusted days waited |
|
<4 weeks | 155 (26.4) |
4–8 weeks | 198 (33.7) |
>8 weeks | 235 (40.0) |
|
|
Psychological factors | |
Trait anxiety score |
|
<45 | 469 (80.4) |
≥45 | 114 (19.6) |
CES-D score |
|
<16 | 372 (63.3) |
≥16 | 216 (36.7) |
Anxiety and/or depression | |
No | 353 (60.5) |
Yes | 230 (39.5) |
|
|
Physiological factors, gynaecological | |
Current menstruation status | |
Not stopped | 305 (51.7) |
Unsure/irregular | 42 (7.1) |
Stopped naturally | 181 (30.7) |
Stopped surgically | 62 (10.5) |
Taking hormone replacement therapy | |
Yes | 34 (5.8) |
No | 556 (94.2) |
Birth control pills in the past month |
|
Yes | 46 (7.9) |
No | 536 (92.1) |
Preoperative malignancy status |
|
Possibly malignant | 137 (23.3) |
Malignant | 102 (17.3) |
Not malignant | 349 (59.4) |
|
|
Physical symptoms | |
Pain intensity scale (BPI) |
|
≤3/10 | 392 (66.7) |
>3/10 | 196 (33.3) |
Pain interference scale (BPI) |
|
≤3/10 | 395 (67.2) |
>3/10 | 193 (32.8) |
Potentially significant (
Generally, the pain intensity and pain interference models were similar (Tables
Unadjusted and adjusted analysis of association between
<3 visits | ≥3 visits | Pain intensity model OR (95% CI) | Pain interference model OR (95% CI) | |||||
---|---|---|---|---|---|---|---|---|
|
|
Unadjusted | Adjusted (full) | Adjusted (reduced) | Unadjusted | Adjusted (full) | Adjusted (reduced) | |
Demographic covariates | ||||||||
Age |
1.07 (1.02–1.11) | 1.09 (1.04–1.14) | 1.08 (1.03–1.13) | 1.08 (1.04–1.12) | 1.10 (1.05–1.15) | 1.10 (1.05–1.14) | ||
Marital status | ||||||||
Single/divorced/widowed | 133 (80.1) | 33 (19.9) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
Married | 320 (76.2) | 100 (23.8) | 1.26 (0.81–1.96) | 1.58 (0.93–2.67) | 1.35 (0.82–2.22) | 1.26 (0.81–1.96) | 1.59 (0.94–2.70) | 1.38 (0.84–2.27) |
Employment status | ||||||||
Not employed/retired/other | 164 (80.4) | 40 (19.6) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Employed full time or part time | 287 (75.3) | 94 (24.7) | 1.34 (0.89–2.04) | 1.26 (0.75–2.12) | 1.34 (0.89–2.04) | 1.30 (0.77–2.18) | ||
Education | ||||||||
High school diploma or less | 146 (78.5) | 40 (21.5) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
More than high school | 307 (76.8) | 93 (23.3) | 1.11 (0.73–1.68) | 1.08 (0.65–1.80) | 1.11 (0.73–1.68) | 1.01 (0.61–1.67) | ||
|
||||||||
Clinical covariates | ||||||||
BMI | ||||||||
≥30 | 196 (77.2) | 58 (22.8) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
<30 | 252 (77.1) | 75 (22.9) | 1.01 (0.68–1.49) | 1.10 (0.69–1.74) | 1.01 (0.68–1.49) | 1.19 (0.75–1.88) | ||
Current smoker | ||||||||
No | 369 (79.5) | 95 (20.5) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
Yes | 84 (68.9) | 38 (31.1) | 1.76 (1.13–2.74) | 1.41 (0.85–2.37) | 1.41 (0.86–2.32) | 1.76 (1.13–2.74) | 1.50 (0.90–2.50) | 1.46 (0.89–2.40) |
Previous abdominal surgery | ||||||||
No | 154 (86.0) | 25 (14.0) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
Yes | 296 (73.6) | 106 (26.4) | 2.21 (1.37–3.56) | 2.37 (1.37–4.09) | 2.16 (1.28–3.65) | 2.21 (1.37–3.56) | 2.45 (1.41–4.24) | 2.31 (1.37–3.91) |
|
||||||||
Situational factors | ||||||||
Adjusted days waited | ||||||||
≤8 weeks | 272 (77.5) | 79 (22.5) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
>8 weeks | 180 (76.9) | 54 (23.1) | 1.03 (0.70–1.53) | 0.75 (0.47–1.22) | 1.03 (0.70–1.53) | 0.81 (0.50–1.30) | ||
|
||||||||
Psychological factors | ||||||||
Anxiety and/or depression | ||||||||
No | 287 (81.8) | 64 (18.2) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 161 (70.0) | 69 (30.0) | 1.92 (1.30–2.84) | 1.10 (0.69–1.75) | 1.92 (1.30–2.84) | 1.01 (0.63–1.63) | ||
|
||||||||
Physiological factors, gynaecological | ||||||||
Current menstruation status | ||||||||
Not stopped or unsure | 258 (74.8) | 87 (25.2) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Stopped surgically or naturally | 195 (80.6) | 47 (19.4) | 0.71 (0.48–1.07) | 1.35 (0.73–2.48) | 0.71 (0.48–1.07) | 1.49 (0.81–2.73) | ||
Taking hormone replacement therapy | ||||||||
No | 431 (77.8) | 123 (22.2) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 22 (66.7) | 11 (33.3) | 1.75 (0.83–3.71) | 1.75 (0.73–4.21) | 1.75 (0.83–3.71) | 1.76 (0.73–4.24) | ||
Birth control pills in the past month | ||||||||
No | 415 (77.9) | 118 (22.1) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 33 (71.7) | 13 (28.3) | 1.39 (0.71–2.72) | 1.13 (0.52–2.48) | 1.39 (0.71–2.72) | 1.22 (0.55–2.67) | ||
Preoperative malignancy status | ||||||||
Possibly/definitely malignant | 198 (83.2) | 40 (16.8) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
Not malignant | 254 (73.2) | 93 (26.8) | 1.81 (1.20–2.74) | 1.42 (0.83–2.43) | 1.44 (0.89–2.33) | 1.81 (1.20–2.74) | 1.44 (0.85–2.45) | 1.45 (0.90–2.34) |
Note: main effects for the interaction term age
The pain intensity model included the age
BPI: Brief Pain Inventory, NA: not applicable, and NS: not selected for final model.
Unadjusted and adjusted analysis of association between
<3 visits | ≥3 visits | Pain intensity model OR (95% CI) | Pain interference model OR (95% CI) | |||||
---|---|---|---|---|---|---|---|---|
|
|
Unadjusted | Adjusted (full) | Adjusted (reduced) | Unadjusted | Adjusted (full) | ||
Physical symptoms | ||||||||
Pain intensity scale (BPI) | ||||||||
≤3/10 | 355 (91.0) | 35 (9.0) | 1.0 | 1.0 | 1.0 | NA | NA | NA |
>3/10 | 139 (70.9) | 57 (29.1) | 4.16 (2.61–6.62) | 3.34 (2.00–5.56) | 3.53 (2.18–5.74) | NA | NA | NA |
Pain interference scale (BPI) | ||||||||
≤3/10 | 354 (90.1) | 39 (9.9) | NA | NA | NA | 1.0 | 1.0 | 1.0 |
>3/10 | 140 (72.5) | 53 (27.5) | NA | NA | NA | 3.44 (2.17–5.43) | 2.88 (1.69–4.91) | 2.90 (1.79–4.69) |
|
||||||||
Demographic covariates | ||||||||
Age | ||||||||
Years (mean (SD)) | 49.2 (11.4) | 44.0 (9.6) | 0.96 (0.94–0.98) | 0.96 (0.93–1.00) | 0.97 (0.95–0.99) | 0.96 (0.94–0.98) | 0.96 (0.93–0.99) | 0.97 (0.95–1.00) |
Marital status | ||||||||
Single/divorced/widowed | 144 (86.2) | 23 (13.8) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Married | 352 (83.8) | 68 (16.2) | 1.21 (0.73–2.02) | 1.40 (0.79–2.49) | 1.21 (0.73–2.02) | 1.37 (0.78–2.43) | ||
Employment status | ||||||||
Not employed/retired/other | 175 (85.8) | 29 (14.2) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Employed full or part time | 319 (83.5) | 63 (16.5) | 1.19 (0.74–1.92) | 1.03 (0.59–1.80) | 1.19 (0.74–1.92) | 1.03 (0.59–1.80) | ||
Education | ||||||||
High school diploma or less | 156 (83.9) | 30 (16.1) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
More than high school | 339 (84.5) | 62 (15.5) | 0.95 (0.59–1.53) | 0.91 (0.52–1.58) | 0.95 (0.59–1.53) | 0.89 (0.51–1.53) | ||
|
||||||||
Clinical covariates | ||||||||
BMI | ||||||||
≥30 | 213 (83.9) | 41 (16.1) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
<30 | 278 (84.8) | 50 (15.2) | 0.93 (0.60–1.47) | 0.97 (0.59–1.61) | 0.93 (0.60–1.47) | 1.00 (0.61–1.66) | ||
Current smoker | ||||||||
No | 402 (86.6) | 62 (13.4) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
Yes | 94 (76.4) | 29 (23.6) | 2.00 (1.22–3.28) | 1.63 (0.94–2.83) | 1.70 (0.99–2.90) | 2.00 (1.22–3.28) | 1.72 (1.00–2.98) | 1.77 (1.04–3.00) |
Previous abdominal surgery | ||||||||
No | 161 (89.9) | 18 (10.1) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
Yes | 332 (82.4) | 71 (17.6) | 1.91 (1.10–3.32) | 1.73 (0.94–3.15) | 1.69 (0.95–3.00) | 1.91 (1.10–3.32) | 1.74 (0.95–3.17) | 1.72 (0.97–3.04) |
|
||||||||
Situational factors | ||||||||
Adjusted days waited | ||||||||
≤8 weeks | 300 (85.2) | 52 (14.8) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
>8 weeks | 194 (82.9) | 40 (17.1) | 1.19 (0.76–1.87) | 0.91 (0.54–1.54) | 1.19 (0.76–1.87) | 0.96 (0.57–1.62) | ||
|
||||||||
Psychological factors | ||||||||
Anxiety and/or depression | ||||||||
No | 309 (87.8) | 43 (12.2) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 181 (78.7) | 49 (21.3) | 1.95 (1.24–3.05) | 1.21 (0.73–2.02) | 1.95 (1.24–3.05) | 1.13 (0.67–1.91) | ||
|
||||||||
Physiological factors, gynaecological | ||||||||
Current menstruation status | ||||||||
Not stopped or unsure | 284 (82.1) | 62 (17.9) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Stopped surgically or naturally | 212 (87.6) | 30 (12.4) | 0.65 (0.40–1.04) | 1.19 (0.61–2.32) | 0.65 (0.40–1.04) | 1.29 (0.66–2.52) | ||
Taking hormone replacement therapy | ||||||||
No | 472 (85.0) | 83 (15.0) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 24 (72.7) | 9 (27.3) | 2.13 (0.96–4.75) | 2.14 (0.88–5.19) | 2.13 (0.96–4.75) | 2.12 (0.88–5.12) | ||
Birth control pills in the past month | ||||||||
No | 450 (84.3) | 84 (15.7) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 38 (82.6) | 8 (17.4) | 1.13 (0.51–2.50) | 0.90 (0.36–2.24) | 1.13 (0.51–2.50) | 0.98 (0.39–2.44) | ||
Preoperative malignancy status | ||||||||
Possibly/definitely malignant | 214 (89.5) | 25 (10.5) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
Not malignant | 280 (80.7) | 67 (19.3) | 2.05 (1.25–3.35) | 1.56 (0.90–2.68) | 1.56 (0.97–2.82) | 2.05 (1.25–3.35) | 1.60 (0.89–2.88) | 1.61 (0.94–2.76) |
BPI: Brief Pain Inventory, NA: not applicable, and NS: not selected for final model.
Unadjusted and adjusted analysis of association between
0 visits | ≥1 visit | Pain intensity model OR (95% CI) | Pain interference model OR (95% CI) | |||||
---|---|---|---|---|---|---|---|---|
|
|
Unadjusted | Adjusted (full) | Adjusted (reduced) | Unadjusted | Adjusted (full) | ||
Physical symptoms | ||||||||
Pain intensity scale (BPI) | ||||||||
≤3/10 | 323 (82.6) | 68 (17.4) | 1.0 | 1.0 | 1.0 | NA | NA | NA |
>3/10 | 123 (62.8) | 73 (37.2) | 2.82 (1.91–4.16) | 2.48 (1.59–3.88) | 2.35 (1.53–3.61) | NA | NA | NA |
Pain interference scale (BPI) | ||||||||
≤3/10 | 329 (83.5) | 65 (16.5) | NA | NA | NA | 1.0 | 1.0 | 1.0 |
>3/10 | 117 (60.6) | 76 (39.4) | NA | NA | NA | 3.29 (2.22–4.87) | 3.01 (1.88–4.83) | 2.81 (1.80–4.40) |
|
||||||||
Demographic covariates | ||||||||
Age | ||||||||
Years (mean (SD)) | 49.7 (11.5) | 44.3 (9.4) | 0.95 (0.94–0.97) | 0.95 (0.93–0.98) | 0.96 (0.94–0.98) | 0.95 (0.94–0.97) | 0.95 (0.93–0.98) | 0.96 (0.94–0.98) |
Marital status | ||||||||
Single/divorced/widowed | 130 (77.8) | 37 (22.2) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Married | 317 (75.3) | 104 (24.7) | 1.15 (0.75–1.77) | 1.25 (0.77–2.05) | 1.15 (0.75–1.77) | 1.25 (0.77–2.05) | ||
Employment status | ||||||||
Not employed/retired/other | 166 (81.4) | 38 (18.6) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Employed full time or part time | 280 (73.1) | 103 (26.9) | 1.61 (1.06–2.44) | 1.82 (1.10–3.02) | 1.61 (1.06–2.44) | 1.85 (1.11–3.07) | ||
Education | ||||||||
High school diploma or less | 149 (79.7) | 38 (20.3) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
More than high school | 298 (74.3) | 103 (25.7) | 1.36 (0.89–2.06) | 1.24 (0.76–2.04) | 1.36 (0.89–2.06) | 1.22 (0.74–2.01) | ||
|
||||||||
Clinical covariates | ||||||||
BMI | ||||||||
≥30 | 201 (79.1) | 53 (20.9) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
<30 | 246 (74.8) | 83 (25.2) | 1.28 (0.86–1.89) | 1.36 (0.87–2.11) | 1.34 (0.87–2.04) | 1.28 (0.86–1.89) | 1.48 (0.94–2.32) | 1.44 (0.94–2.22) |
Current smoker | ||||||||
No | 362 (77.8) | 103 (22.2) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 86 (69.9) | 37 (30.1) | 1.51 (0.97–2.36) | 1.08 (0.65–1.80) | 1.51 (0.97–2.36) | 1.14 (0.68–1.90) | ||
Previous abdominal surgery | ||||||||
No | 144 (80.4) | 35 (19.6) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 301 (74.5) | 103 (25.5) | 1.41 (0.91–2.17) | 1.40 (0.86–2.28) | 1.41 (0.91–2.17) | 1.40 (0.85–2.29) | ||
|
||||||||
Situational factors | ||||||||
Adjusted days waited | ||||||||
≤8 weeks | 261 (73.9) | 92 (26.1) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
>8 weeks | 186 (79.5) | 48 (20.5) | 0.73 (0.49–1.09) | 0.54 (0.33–0.86) | 0.63 (0.41–0.97) | 0.73 (0.49–1.09) | 0.56 (0.35–0.90) | 0.65 (0.42–1.00) |
|
||||||||
Psychological factors | ||||||||
Anxiety and/or depression | ||||||||
No | 290 (82.2) | 63 (17.8) | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 | 1.0 |
Yes | 154 (67.0) | 76 (33.0) | 2.27 (1.54–3.34) | 2.00 (1.29–3.11) | 1.75 (1.15–2.68) | 2.27 (1.54–3.34) | 1.74 (1.10–2.74) | 1.54 (0.99–2.38) |
|
||||||||
Physiological factors, gynaecological | ||||||||
Current menstruation status | ||||||||
Not stopped or unsure | 255 (73.7) | 91 (26.3) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Stopped surgically or naturally | 193 (79.4) | 50 (20.6) | 0.73 (0.49–1.07) | 1.74 (0.98–3.08) | 0.73 (0.49–1.07) | 1.92 (1.07–3.43) | ||
Taking hormone replacement therapy | ||||||||
No | 424 (76.4) | 131 (23.6) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 24 (70.6) | 10 (29.4) | 1.35 (0.63–2.89) | 1.39 (0.60–3.22) | 1.35 (0.63–2.89) | 1.34 (0.57–3.14) | ||
Birth control pills in the past month | ||||||||
No | 409 (76.4) | 126 (23.6) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Yes | 32 (69.6) | 14 (30.4) | 1.42 (0.73–2.74) | 1.01 (0.47–2.19) | 1.42 (0.73–2.74) | 1.15 (0.53–2.51) | ||
Preoperative malignancy status | ||||||||
Possibly/definitely malignant | 188 (78.7) | 51 (21.3) | 1.0 | 1.0 | NS | 1.0 | 1.0 | NS |
Not malignant | 259 (74.4) | 89 (25.6) | 1.27 (0.86–1.87) | 1.04 (0.63–1.70) | 1.27 (0.86–1.87) | 1.06 (0.64–1.74) |
BPI: Brief Pain Inventory, NA: not applicable, and NS: not selected for final model.
In the adjusted analysis where age and pain intensity/interference were stratified for visits to the family doctor (Table
Exploration of the interaction between age and pain intensity and frequent visits to the family doctor.
≥3 visits to the family doctor | |||||
---|---|---|---|---|---|
Age | Pain intensity | <3 visits | ≥3 visits | OR (95% CI) | |
|
|
Unadjusted | Adjusted (reduced) | ||
|
|||||
≤50 | ≤3 | 185 (81.9) | 41 (18.1) | 1.0 | 1.0 |
≤50 | >3 | 74 (53.2) | 65 (46.8) | 3.96 (2.47–6.37) | 3.46 (2.11–5.69) |
>50 | ≤3 | 151 (94.4) | 9 (5.6) | 0.27 (0.13–0.57) | 0.30 (0.14–0.65) |
>50 | >3 | 38 (69.1) | 17 (30.9) | 2.02 (1.04–3.92) | 2.36 (1.16–4.81) |
|
|||||
Age | Pain interference | ||||
|
|||||
≤50 | ≤3 | 178 (79.8) | 45 (20.2) | 1.0 | 1.0 |
≤50 | >3 | 81 (57.0) | 61 (43.0) | 2.98 (1.87–4.75) | 2.68 (1.62–4.43) |
>50 | ≤3 | 156 (94.0) | 10 (6.0) | 0.25 (0.12–0.52) | 0.29 (0.14–0.60) |
>50 | >3 | 33 (67.3) | 16 (32.7) | 1.92 (0.97–3.79) | 2.31 (1.11–4.81) |
Note: smoking status, prior abdominal surgery, anxiety and/or depression, and malignancy status were included in adjusted model.
The overall aim of this study was to gain a better understanding of pain-related healthcare needs of participants waiting for gynaecological surgery. Approximately one-third of these women experienced symptoms of mental distress, pain interference, and/or moderate to severe pain intensity during the preoperative period. One of the major findings was that the average participant sought healthcare for pain 3.5 times in the 12 months before surgery, and family doctors were the main settings from which they sought help; however, frequent visits to the family doctor did not necessarily mean fewer visits to the ED. In addition, different characteristics were associated with seeking care from EDs or walk-in clinics, compared to the family doctor or a specialist. Depression and/or anxiety, which is highly correlated with pain, was associated with visits to an ED or walk-in clinic but not the family doctor or a specialist.
Overall, our results show that 20% of participants experienced symptoms of anxiety and 37% demonstrated a risk of depression needing treatment, which are similar to other reports of preoperative mental distress in women waiting for gynaecological surgery [
Approximately one-third of the study participants experienced pain of at least a moderate intensity and level of interference, suggesting that there is a significant burden of pain experienced in women waiting for gynaecological surgery. As over 60% of participants reported at least one pain-related healthcare visit in the preceding year, these estimates of pain intensity and interference are likely conservative. Participants experiencing severe interference with normal work activities only, for example, may have had a low total interference score yet still visited a health professional for care. Our finding that participants with moderate to severe pain intensity and pain interference were more likely to seek healthcare is consistent with prior research in pain groups [
Having a history of prior abdominal surgery was a predictor of high pain-related HCU. No other studies have examined or identified the association between history of surgery and HCU. Individuals with prior abdominal surgery may have more complex health conditions, including chronic postsurgical pain [
Study limitations include the use of self-report of HCU and physiological and psychological symptoms. Recall bias may be present due to the need to recall HCU for pain over the previous 12 months. A review of literature on recall bias regarding HCU found conflicting information between the accuracy of patient self-reports and medical records. The underreporting of HCU was found in cases where HCU is high [
The primary purpose of the main study was to understand the development of chronic postsurgical pain [
The response rate of 63% is higher than rates from prevalence studies on chronic pain [
The results suggest that individuals with a history of prior abdominal surgery and either moderate to severe pain intensity or interference would make good targets for interventions to reduce high HCU. As primary care was the most commonly identified setting from which women sought pain-related care, this may be the ideal setting to deliver interventions. There is currently a paucity of interventions that have evaluated the effect of pelvic pain interventions on HCU [
Empirical evidence suggests that management of pain improves with early intervention [
This study has provided evidence that women experience unpleasant symptoms while waiting for gynaecologic surgery. In particular, a substantial number of visits to healthcare providers occur because of pain. Consideration of physical and psychological factors, in addition to issues directly related to the primary reason for surgery, may improve outcomes while reducing HCU at the same time as individuals await surgery. However, further research is needed to assess the effectiveness of interventions designed to target psychological and physical needs of patients prior to surgery.
This study examines pain and healthcare use (HCU) in 590 women in the year prior to gynaecological surgery. One-third reported moderate to severe (>3/10) pain intensity and interference before surgery. Three hundred and sixty women reported 2026 healthcare visits in the year before surgery. The odds of high HCU (≥3 pain-related visits to family doctor or specialist annually, ≥1 to emergency/urgent care) increased in the presence of moderate to severe pain. These findings illustrate the high burden of pain in women awaiting gynaecological surgery and its impact on healthcare use.
The original study was supported by an operating grant held by Dr. VanDenKerkhof from the Canadian Institutes of Health Research (no. 79522). Sarah Walker was supported by a Queen’s University Graduate Award, a Queen’s University International Tuition Award, and a Registered Nurses Association of Ontario Education Initiative Award.
The authors declare that they have no competing interests.
The authors acknowledge the contributions of the research team for the original study (David Goldstein, Rosemary Wilson, Tanveer Towheed, Miu Lam, Margaret Harrison, Michelle Reitsma, Shawna Johnston, James Medd, and Ian Gilron).