Theunissen Maurice, Peters Madelon L, Schepers Jan, Maas Jacques W M, Tournois Fleur, van Suijlekom Hans A, Gramke Hans-Fritz, Marcus Marco A E
aDepartment of Anesthesiology and Pain Management, Maastricht UMC+ bDepartment of Clinical Psychological Science, Maastricht University, Maastricht cDepartment of Gynecology, Máxima Medical Center, Veldhoven dDepartment of Gynaecology, Maastricht UMC+, Maastricht/Orbis Medical Center, Sittard-Geleen eDepartment of Anesthesiology and Pain Management, Catharina Hospital, Eindhoven, The Netherlands fDepartment of Anesthesiology, ICU, and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.
Medicine (Baltimore). 2016 Jun;95(26):e3980. doi: 10.1097/MD.0000000000003980.
Chronic postsurgical pain (CPSP) is 1 important aspect of surgical recovery. To improve perioperative care and postoperative recovery knowledge on predictors of impaired recovery is essential. The aim of this study is to assess predictors and epidemiological data of CPSP, physical functioning (SF-36PF, 0-100), and global surgical recovery (global surgical recovery index, 0-100%) 3 and 12 months after hysterectomy for benign indication.A prospective multicenter cohort study was performed. Sociodemographic, somatic, and psychosocial data were assessed in the week before surgery, postoperatively up to day 4, and at 3- and 12-month follow-up. Generalized linear model (CPSP) and linear-mixed model analyses (SF-36PF and global surgical recovery index) were used. Baseline data of 468 patients were collected, 412 (88%) patients provided data for 3-month evaluation and 376 (80%) patients for 12-month evaluation.After 3 and 12 months, prevalence of CPSP (numeric rating scale ≥ 4, scale 0-10) was 10.2% and 9.0%, respectively, SF-36PF means (SD) were 83.5 (20.0) and 85.9 (20.2), global surgical recovery index 88.1% (15.6) and 93.3% (13.4). Neuropathic pain was reported by 20 (5.0%) patients at 3 months and 14 (3.9%) patients at 12 months. Preoperative pain, surgery-related worries, acute postsurgical pain on day 4, and surgery-related infection were significant predictors of CPSP. Baseline level, participating center, general psychological robustness, indication, acute postsurgical pain, and surgery-related infection were significant predictors of SF-36PF. Predictors of global surgical recovery were baseline expectations, surgery-related worries, American Society of Anesthesiologists classification, type of anesthesia, acute postsurgical pain, and surgery-related infection.Several predictors were identified for CPSP, physical functioning, and global surgical recovery. Some of the identified factors are modifiable and optimization of patients' preoperative pain status and psychological condition as well as reduction of acute postsurgical pain and surgery-related infection may lead to improvement of outcome.
慢性术后疼痛（CPSP）是手术恢复的一个重要方面。为了改善围手术期护理和术后恢复，了解恢复受损的预测因素至关重要。本研究的目的是评估因良性指征行子宫切除术后3个月和12个月时CPSP、身体功能（SF-36PF，0-100）和整体手术恢复情况（整体手术恢复指数，0-100%）的预测因素和流行病学数据。
进行了一项前瞻性多中心队列研究。在手术前一周、术后至第4天以及3个月和12个月随访时评估社会人口统计学、躯体和心理社会数据。使用广义线性模型（用于CPSP）和线性混合模型分析（用于SF-36PF和整体手术恢复指数）。收集了468例患者的基线数据，412例（88%）患者提供了3个月评估的数据，376例（80%）患者提供了12个月评估的数据。
3个月和l2个月后，CPSP的患病率（数字评定量表≥4，范围0-10）分别为10.2%和9.0%，SF-36PF均值（标准差）分别为83.5（20.0）和85.9（20.2），整体手术恢复指数分别为88.1%（15.6）和93.3%（13.4）。3个月时有20例（5.0%）患者报告有神经性疼痛，12个月时有14例（3.9%）患者报告有神经性疼痛。术前疼痛、与手术相关的担忧、术后第4天的急性术后疼痛以及与手术相关的感染是CPSP的显著预测因素。基线水平、参与中心、一般心理韧性、指征、急性术后疼痛和与手术相关的感染是SF-36PF的显著预测因素。整体手术恢复的预测因素是基线期望、与手术相关的担忧、美国麻醉医师协会分级、麻醉类型、急性术后疼痛和与手术相关的感染。
确定了CPSP、身体功能和整体手术恢复的几个预测因素。一些已确定的因素是可改变的，优化患者的术前疼痛状态和心理状况，以及减少急性术后疼痛和与手术相关的感染可能会改善预后。
