The association between migraine and hospital readmission due to pain after surgery: A hospital registry study

Abstract

Background Migraine has been identified as a risk factor of 30-day hospital readmission after surgery. We aimed to further characterize this association examining pain as a potentially migraine-associated, preventable reason for readmission. Hypothesis Compared to patients with no migraine, surgical patients with migraine are at increased risk of 30-day hospital readmission with an admitting diagnosis specifying pain. Methods This hospital registry study examined 150,710 patients aged 18 years and above, who underwent surgery with general anesthesia and mechanical ventilation between 2007 and 2015 at a tertiary care center and two affiliated community hospitals in Massachusetts, USA. Results Migraine was associated with an increased risk of 30-day pain-related readmission after surgery (adjusted odds ratio 1.42 [95% confidence interval 1.15–1.75]). The association was stronger for migraine with aura (compared to migraine without aura: Adjusted odds ratio 1.69 [95% confidence interval 1.06–2.70]; compared to no migraine: Adjusted odds ratio 2.20 [95% confidence interval 1.44–3.37]). The predicted adjusted risk of pain-related 30-day readmissions was 9.1 [95% confidence interval 5.3–13.0] in 1000 surgical patients with migraine with aura and 5.4 [95% confidence interval 4.2–6.6] in 1000 patients with migraine without aura, compared to 4.2 [95% confidence interval 3.8–4.5] in 1000 patients with no migraine. Furthermore, migraine was associated with an increased risk of postsurgical 30-day readmission due to a priori defined migraine-related pain (headache or abdominal pain) (adjusted odds ratio 1.55 [95% confidence interval 1.20–2.00]). Conclusion Patients with migraine undergoing surgery are at increased risk of 30-day hospital readmission due to pain.