The relationship of persistent post-surgery pain after cardiac surgery and anxiety, depression, and attachment style: a single center longitudinal study.

Abstract

Background: The development of persistent post-surgical pain (PPSP) is an important issue in cardiosurgery, as it can both predict and result from psychological phenomena such as depression or anxiety. This study aimed to identify differences between cardiac surgery patients with and without PPSP at 3- and 12-months post-surgery in various psychological domains. Methods: This is a single-center prospective longitudinal study. N = 125 patients who underwent cardiac surgery in the years 2018-2020 at the Department of Cardiac Surgery of the 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic, were psychologically examined before the operation and by surface mail 3 and 12 months after the operation. Postoperative pain intensity was measured using a visual analog scale (VAS), Pain Map localization, Beck Depression Inventory-II (BDI-II) to measure depression, and Generalized Anxiety Disorder Assessment (GAD-7) to measure anxiety, to assess the relationship The Relationship Questionnaire (RQ). Patients were divided into two groups: the first, which met the criteria for persistent postoperative pain (PPSP), and the second, which had no PPSP. N = 94 patients responded 3 months after surgery and N = 72 patients 12 months after surgery. Results: 3 months after surgery there were N = 67 (71.28%) patients with PPSP and N = 27 (28.72%) without PPSP, 12 months after surgery there were N = 44 (61.11%) patients with PPSP and N = 28 (38.89%) patients without PPSP. The results showed that patients with PPSP in both measurements had a significantly higher level of intensity of pain and discomfort (P < 0.001, P < 0.001), depression (P < 0.001, P < 0.001) and anxiety (P < 0.001, P < 0.001) as well as a higher probability of insecure attachment (P = 0.011), were more often female (P = 0.020, P = 0.005) and older than those without PPSP (P = 0.031). Conclusions: This study is the first to prospectively examine the psychological factors associated with PPSP in Czech cardiac surgery patients over a 12-month period. Such studies could help provide valuable information for preventive interventions in individuals in postoperative pain control and in individuals with postsurgical persistent pain targeting anxiety, depression, and adult attachment styles.