Incidence, Severity, and Interference of Chronic Postsurgical Pain After Cesarean Delivery: A Systematic Review and Meta-analysis
Authors' conclusion
CPSP after CD occurs in 16.7 % of patients at ≥3 to <6 months postpartum and widely interferes with maternal HR-QoL domains in the majority of those affected.
Study context
- Population
- Women after cesarean delivery (CD)
- Participants
- 13,149 women · 50 studies
- Outcome
- Incidence of CPSP (wound, scar or abdomen)
- Follow-up
- ≥3 to <6 months, ≥6 to <12, and ≥ 12 months
Methodological detailsrandom-effects model, meta-regression, GRADE, GRADE quality of evidence very low for all outcomes, Search of 7 databases, January 2015 to August 2023, added to 29 studies from a 2016 review
- Random-effects model
- Meta-regression
- GRADE
- GRADE quality of evidence very low for all outcomes
- Search of 7 databases, January 2015 to August 2023, added to 29 studies from a 2016 review
Pooled result
As reported in the abstract
Incidence of scar-specific CPSP (meta-analysis, n = 9228; 9 RCTs and 20 observational)
Incidence at ≥3 to <6 months (C·I. 13.1 to 20.4 %; I2 = 97.0 %; p < 0.001)
16.7 %
Incidence at ≥6 to <12 months
11.4 %
95 % CI 8.7 to 14.0 %; I2 = 94.1 %P < 0.001
Incidence at ≥12 months
8.8 %
95 % CI 6.6 to 11.0 %; I2 = 97.3 %P < 0.001
Further pooled results
Trend in chronic postsurgical pain (CPSP) incidence by publication year (meta-regression)
- Stable CPSP incidence from 2002 onwards
Pain intensity at rest · ≥6 to <12 months
%
- Mild pain at rest (95 % C·I: 18.7 to 83.8 %)
- 51.2
- Severe pain at rest (95 % C·I: 0 to 27.1 %)
- 13.5
Interference with health-related quality of life (HR-QoL) (Brief Pain Inventory)
- Interference in all 7 subdomains in the majority of patients
- >50 %
- Walking ability impacted at ≥3 to <6 months
- 67.6 % (95 % CI 57.6 to 77.6 %; I2 = 50 %)
- Normal work impacted at ≥6 to <12 months
- 69.4 % (95 % CI 59.3 to 79.6 %; I2 = 18.6 %)
- Enjoyment of life impacted at ≥6 to <12 months (67.1 to 91.9 %; I2 = 59.3 %)
- 79.5 %
- Estimated patients with CPSP interfering with daily life, work, social life and personal care
- 10 %
Original publication
Incidence, Severity, and Interference of Chronic Postsurgical Pain After Cesarean Delivery: A Systematic Review and Meta-analysis. J Clin Anesth. Published 24 April 2025. doi:10.
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