J Korean Acad Nurs.  2020 Apr;50(2):159-177. 10.4040/jkan.2020.50.2.159.

Factors Related to Persistent Postoperative Pain after Cardiac Surgery: A Systematic Review and Meta-Analysis

  • 1College of Nursing, University of Iowa, Iowa City, IA, USA
  • 2College of Nursing, Ewha Womans University, Seoul, Korea


This study aimed at identifying factors related to persistent postoperative pain after cardiac surgery and estimating their effect sizes.
The literature search and selection was conducted in four different databases (CINAHL, Cochrane Library, PubMed, and PQDT) using the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement. A total of 14 studies met the inclusion criteria and were systematically reviewed. For the meta-analysis, R was used to analyze 30 effect sizes of for both individual and operative factors as well as publication biases from a total of nine studies.
The meta-analysis revealed that persistent postoperative pain after cardiac surgery was related to one individual factor (gender) and two operative factors (acute postoperative pain and use of the internal mammary artery). Operative factors (OR=5.26) had a larger effect size than individual factors (OR=1.53).
Female gender, acute pain after surgery, and use of the internal mammary artery are related factors to persistent postoperative pain. The development of interventions focusing on modifiable related factors, such as acute postoperative pain, may help to minimize or prevent PPP after cardiac surgery.


Pain; Postoperative; Cardiac Surgical Procedure; Meta-Analysis; Systematic Review
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