A Multi-Institutional and Nationwide Analysis of the Social Determinants of Persistent Pain After Surgery.

Abstract

Despite advancements in acute pain management and minimally invasive surgical techniques, persistent postsurgical pain can occur in up to 30% to 50% of patients. Psychological and social factors are increasingly recognized as contributors to pain outcomes, yet the impact of specific social determinants of health on persistent postoperative pain remains unclear. We conducted a retrospective observational study using the All of Us Research Program database. Adults who underwent surgical procedures after the year 2000 were included if they had available social determinants of health (SDoH) survey data and no prior diagnosis of persistent postoperative pain. Persistent postoperative pain was defined via SNOMED codes as a diagnosis occurring at least 1 year after the surgery date. Multivariable logistic regression was performed to assess the association between 21 independent variables derived from All of Us SDoH survey items and persistent postoperative pain, controlling for age, sex, race, ethnicity, and surgery type. A Bonferroni-corrected significance threshold ( P < .002) was applied. There were 8065 participants included in the final analysis with 641 (7.9%) developing persistent postoperative pain. Food insecurity had the strongest association with persistent postoperative pain (odds ratio [OR] = 1.83, 95% confidence interval [CI], 1.45-2.30, P < .001). Having greater social support (OR = 0.96, 95% CI, 0.94-0.99, P = .002) and lower residential density (OR = 0.72, 95% CI, 0.61-0.85, P < .001) was protective. These findings underscore the importance of routinely assessing and addressing socioeconomic and psychosocial factors in perioperative care to help prevent long-term pain.