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Impact of pain catastrophizing in women undergoing pelvic floor surgery

      Objectives

      To compare rates of voiding trial (VT) failure after urogynecologic surgery in women with versus (vs) without pain catastrophizing. Additionally, pelvic floor symptom bother and impact were compared between groups.

      Materials and Methods

      Women undergoing urogynecologic surgery 03/2020 to 03/2021, who completed a preoperative pain catastrophizing scale (PCS, score range 0 to 52) were included in this retrospective cohort study. Pain catastrophizing was defined as PCS score ≥30 preoperatively. Women also completed the Pelvic Floor Impact Questionnaire Short Form (PFIQ-7) as well as the Pelvic Floor Distress Inventory-20 (PFDI-20). Standardized VT was performed within 24 hours postoperatively. VT failure was defined as inability to void ≥2/3 of an instilled maximum tolerated volume (≤300mL). Chi-Square, Fisher’s exact, ANOVA F, and Kruskal-Wallis tests were performed as indicated. Significance level was set at 0.05.

      Results

      106 women were included with mean±SD age of 59±13 years, 93% were white, and mean±SD BMI 28.6±6. 16/106 (15%) had PCS scores ≥30, or pain catastrophizing. There were no differences in baseline POPQ stage, procedures performed (including apical suspension, hysterectomy, and midurethral sling), estimated blood loss and operative time between groups (all p>0.05). Baseline demographics did not differ between women with and without pain catastrophizing except that those with PCS≥30 had higher rates of benzodiazepine use (44 vs 11%, p<0.01) as well as anxiety (56 vs 24%, p=0.01), depression (44 vs 18%, p=0.02), and pain syndromes (25 vs 5%, p=0.02). Additionally, they scored higher on all subscales (urinary, colorectal, and prolapse) of the PFIQ-7 as well as on the PFDI-20 (Table). Women with PCS≥30 were less likely to report stress urinary incontinence preoperatively (38 vs 66%, p=0.03). Failure of first VT did not differ between groups with vs without pain catastrophizing (25 vs 27%, p = 0.8). 4/106 (4%) were unable to pass a VT within 7 days postoperatively. None of these were in the PCS≥30 group.