Migraine Associated With Increased Risk for Postsurgical 30-Day Hospital Readmission for Pain

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Investigators analyzed the electronic records of patients who underwent surgical procedures involving general anesthesia and intubation at 1 urban and 2 community hospitals in Massachusetts.
Investigators analyzed the electronic records of patients who underwent surgical procedures involving general anesthesia and intubation at 1 urban and 2 community hospitals in Massachusetts.

Patients with migraine headaches—particularly those accompanied by aura—may be at significantly increased risk for 30-day hospital readmission because of pain after surgery when compared with individuals without migraines, according to a study published in Cephalalgia.

Although migraines are thought to increase the chance for postoperative readmission to the hospital, the specific reasons underlying this phenomenon are not well understood. Investigators examined the potential link between readmissions and migraines in relation to pain as the presenting symptom and admitting diagnosis, hypothesizing that a diagnosis of migraine headache would predispose patients to hospital readmission secondary to pain.

In this prospective study, investigators analyzed the electronic records of patients who underwent surgical procedures involving general anesthesia and intubation at 1 urban and 2 community hospitals in Massachusetts between 2007 and 2015. The records of individuals with and without a history of migraine were examined, in terms of 30-day hospital readmission for pain after discharge, with adjusted odds ratios (aOR) calculated to estimate risk.

A total of 150,710 participants were enrolled and categorized according to migraine status: individuals without migraine (n=138,942; mean age, 54.94 years; 52.2% women), patients with migraine without aura (n=10,228; mean age, 48.86 years; 80.5% women), and patients with migraine with aura (n=1540; mean age, 46.35 years; 81.4% women). There were 871 patients (0.6%) readmitted for pain within 30 days, with 109 patients with history of migraines.

After multivariable logistic regression, individuals with any type of migraine vs no migraine were found to have an increased risk for readmission for pain (aOR 1.42; 95% CI, 1.15-1.75; P =.001). Migraine with aura posed the greatest risk for readmission when compared with no migraine (aOR 2.20; 95% CI, 1.44-3.37; P <.001) and migraine without aura (aOR 1.69; 95% CI, 1.06-2.70). Migraine without aura was also associated with increased likelihood of readmission for pain vs no migraine (aOR 1.30; 95% CI, 1.03-1.64; P =.026).

The adjusted predicted risk for 30-day pain-related readmission per 1000 patients was 9.1 (95% CI, 5.3-13.0) for migraine with aura and 5.4 (95% CI, 4.2-6.6) for migraine without aura compared with 4.2 (95% CI, 3.8-4.5) for individuals without migraine. In addition, secondary analysis revealed an association of any migraine history with readmission for migraine-related pain (aOR 1.55; 95% CI, 1.20-2.00), defined as headache or abdominal pain. This association represented 68.8% of all pain-related readmissions in individuals with migraines.

Study strengths included a large sample size, wide range of surgeries and surgical settings, generalizability to populations outside the 3 hospitals, and multiple adjustments for potential confounders.

Study limitations included possible misclassification because of reliance on billing records, possible diagnostic inaccuracy, lack of information on individual indications or hospital intake circumstances, and lack of information regarding patient readmission in other establishments.

 "These results substantiate migraine to be the driver for the observed association and a potential target point for measures to prevent readmissions due to pain," concluded the study authors. They recommended that future studies focus on ways to prevent pain-related hospital readmissions of migraine sufferers, potentially via use of migraine abortive therapies.

Funding and Conflict of Interest Disclosures

The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Merck & Co., Inc.: Matthias Eikermann has received investigator-initiated study support and is serving on the advisory board for sugammadex. Tobias Kurth has received honoraria from Lilly for providing methodological advice, from Novartis Pharmaceuticals Corporation for a lecture on neuroepidemiology, and from the British Medical Journal for editorial services. He has provided methodological consultancy to CoLucid Pharmaceuticals, Inc., for which the Charite ́ has received unrestricted funds.

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Reference

Platzbecker K, Zhang MB, Kurth T, et al. The association between migraine and hospital readmission due to pain after surgery: A hospital registry studyCephalalgia. July:1-10.

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