Predictors of post-discharge pain and satisfaction with pain management after laparoscopic bariatric surgery: a prospective cohort study

Background Pain management after bariatric surgery remains challenging given the risk for analgesia-related adverse events (e.g., opioid use disorder, marginal ulcers). Identifying modifiable factors associated with patient-reported pain outcomes may improve quality of care. We evaluated the extent to which patient and procedural factors predict 7-day post-discharge pain intensity, pain interference, and satisfaction with pain management after bariatric surgery. Methods This prospective cohort study included adults undergoing laparoscopic bariatric surgery at two university-affiliated hospitals and one private clinic. Preoperative assessments included demographics, Pain Catastrophizing Scale (score range 0–52), Patient Activation Measure (low [< 55.1] vs. high [≥ 55.1]), pain expectation (0–10), and Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29) anxiety and depression scales. At 7 days post-discharge, assessments included PROMIS-29 pain intensity (0–10) and pain interference scales (41.6–75.6), and satisfaction with pain management (high [10–9] vs. lower [8–0]). Linear and logistic regression were used to assess the association of pain outcomes with potential predictors. Results Three hundred and fifty-one patients were included (mean age = 44 ± 11 years, BMI = 45 ± 8 kg/m 2 , 77% female, 71% sleeve gastrectomy). At 7 days post-discharge, median (IQR) patient-reported pain intensity was 2.5 (1–5), pain interference was 55.6 (52.0–61.2), and 76% of patients reported high satisfaction with pain management. Pain intensity was predicted by preoperative anxiety ( β + 0.04 [95% CI + 0.01 to + 0.07]) and pain expectation (+ 0.15 [+ 0.05 to + 0.25]). Pain interference was predicted by preoperative anxiety (+ 0.22 [+ 0.11 to + 0.33]), pain expectation (+ 0.47 [+ 0.10 to + 0.84]), and age (− 0.09 [− 0.174 to − 0.003]). Lower satisfaction was predicted by low patient activation (OR 1.94 [1.05–3.58]), higher pain catastrophizing (1.03 [1.003–1.05]), 30-day complications (3.27 [1.14–9.38]), and age (0.97 [0.948–0.998]). Conclusion Patient-related factors are important predictors of post-discharge pain outcomes after bariatric surgery. Our findings highlight the value of addressing educational, psychological, and coping strategies to improve postoperative pain outcomes. Graphical abstract