Rabbitts Jennifer A, Palermo Tonya M, Zhou Chuan, Mangione-Smith Rita
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
J Pain. 2015 Dec;16(12):1334-1341. doi: 10.1016/j.jpain.2015.09.005. Epub 2015 Sep 28.
Around 4 million children undergo inpatient surgery in the United States each year, however little is known about the impact of surgery and postoperative pain on children's health-related quality of life (HRQOL) during the weeks and months after surgery. We measured pain and HRQOL in a large, heterogeneous pediatric postsurgical population from baseline to 1-month follow-up. Over a 20-month period, parents of 915 children age 2 to 18 years (mean = 9.6 years), 50% male, 56% white, admitted to surgical services at a children's hospital enrolled in the study. Parent participants reported on sociodemographics, child HRQOL, and pain characteristics at baseline and 1 month after discharge. Although most of the children recovered to baseline by 1 month after hospital discharge, 23% of children had a significant decline in HRQOL. Logistic regression analyses found that increasing child age (odds ratio = 2.1 for age 13-18 years) and the presence of moderate-severe postsurgical pain at 1 month (odds ratio = 5.7) were significantly associated with deterioration in HRQOL from baseline to 1-month follow-up (P < .05 for each variable). Although HRQOL returns to the baseline level for most children, a sizeable proportion have significant deterioration in HRQOL associated with continued postsurgical pain at 1 month after hospital discharge from surgery.
This study addresses an important gap in the literature, examining pain and health-related quality of life in a broad population of children undergoing a wide range of inpatient surgeries. Evaluation of inpatient health services from a patient and family perspective is essential in evaluating outcomes of surgical care.
在美国，每年约有400万儿童接受住院手术，然而，对于手术及术后疼痛对儿童术后数周和数月内与健康相关的生活质量（HRQOL）的影响，人们知之甚少。我们在一个大型、异质性的儿科术后人群中，测量了从基线到1个月随访期间的疼痛和HRQOL。在20个月的时间里，915名年龄在2至18岁（平均 = 9.6岁）的儿童的家长参与了该研究，这些儿童入住一家儿童医院接受手术治疗，其中50%为男性，56%为白人。家长参与者报告了儿童的社会人口统计学特征、HRQOL以及基线和出院后1个月时的疼痛特征。尽管大多数儿童在出院后1个月恢复到了基线水平，但仍有23%的儿童HRQOL显著下降。逻辑回归分析发现，儿童年龄增加（13 - 18岁的优势比 = 2.1）以及术后1个月存在中度至重度疼痛（优势比 = 5.7）与从基线到1个月随访期间HRQOL的恶化显著相关（每个变量P < .05）。尽管大多数儿童的HRQOL恢复到了基线水平，但仍有相当一部分儿童在手术后出院1个月时，HRQOL因持续的术后疼痛而显著恶化。
本研究填补了文献中的一个重要空白，在接受广泛住院手术的大量儿童中，研究了疼痛与健康相关的生活质量。从患者和家庭的角度评估住院医疗服务对于评估手术治疗效果至关重要。
