Incidence, Severity, and Interference of Chronic Postsurgical Pain After Cesarean Delivery: A Systematic Review and Meta-analysis.

BACKGROUND

Chronic postsurgical pain (CPSP) is a common complication following surgery. Cesarean delivery (CD) is the most performed inpatient surgery, however, the true incidence of CPSP after CD in contemporary practice is unknown. This systematic review and meta-analysis aimed to determine the incidence and severity of CPSP after CD and assess interference with maternal health-related quality of life (HR-QoL).

METHODS

A 7-database literature search was used to identify observational and randomized controlled studies (RCTs) reporting the incidence of CPSP following CD (published January 2015 to August 2023). Included studies were added to the 29 studies identified from a prior review published in 2016. The primary outcome was incidence of CPSP (wound, scar or abdomen) between ≥3 to <6 months, ≥6 to <12, and ≥ 12 months. Secondary outcomes were incidence of chronic pain (back, pelvis or other residual); pain intensity at rest and movement-evoked, and chronic pain interference with maternal HR-QoL at each time interval.

RESULTS

50 studies involving 13,149 patients were included. Meta-analysis with random-effects model (n = 9228; 9 RCTs and 20 observational) revealed an incidence of scar-specific CPSP of 16.7 % (C·I. 13.1 to 20.4 %; I2 = 97.0 %; p < 0.001) at ≥3 to <6 months, 11.4 % (95 % CI 8.7 to 14.0 %; I2 = 94.1 %; P < 0.001) at ≥6 to <12 months, and 8.8 % (95 % CI 6.6 to 11.0 %; I2 = 97.3 %; P < 0.001) at ≥12 months. Meta-regression analysis using publication year as the co-variate revealed a stable CPSP incidence from 2002 onwards. Between ≥6 to <12 months, 51.2 % (95 % C·I: 18.7 to 83.8 %) and 13.5 % (95 % C·I: 0 to 27.1 %) of women had mild and severe pain at rest, respectively. CPSP interfered with HR-QoL in all 7 subdomains of the Brief Pain Inventory in the majority (>50 %) of patients. Walking ability was impacted in 67.6 % (95 % CI 57.6 to 77.6 %; I2 = 50 %) at ≥3 to <6 months. Normal work was impacted in 69.4 % (95 % CI 59.3 to 79.6 %; I2 = 18.6 %) and enjoyment of life in 79.5 % (67.1 to 91.9 %; I2 = 59.3 %) at ≥6 to <12 months. Therefore an estimated 10 % of patients experience CPSP after CD that interferes with daily life, work, social life and personal care. The GRADE quality of evidence was rated as very low for all outcomes.

CONCLUSIONS

CPSP after CD occurs in 16.7 % of patients at ≥3 to <6 months postpartum and widely interferes with maternal HR-QoL domains in the majority of those affected. Further studies are required to explore potential mitigating factors and optimal treatment strategies.