Pain Unit, Department of Anesthesiology, Parc de Salut MAR, Institut Municipal d'Investigació Mèdica, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Anesthesiology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
Pain. 2020 Nov;161(11):2611-2618. doi: 10.1097/j.pain.0000000000001945.
No externally validated presurgical risk score for chronic postsurgical pain (CPSP) is currently available. We tested the generalizability of a six-factor risk model for CPSP developed from a prospective cohort of 2929 patients in 4 surgical settings. Seventeen centers enrolled 1225 patients scheduled for inguinal hernia repair, hysterectomy (vaginal or abdominal), or thoracotomy. The 6 clinical predictors were surgical procedure, younger age, physical health (Short Form Health Survey-12), mental health (Short Form Health Survey-12), preoperative pain in the surgical field, and preoperative pain in another area. Chronic postsurgical pain was confirmed by physical examination at 4 months. The model's discrimination (c-statistic), calibration, and diagnostic accuracy (sensitivity, specificity, and positive and negative likelihood ratios) were calculated to assess geographic and temporal transportability in the full cohort and 2 subsamples (historical and new centers). The full data set after exclusions and losses included 1088 patients; 20.6% had developed CPSP at 4 months. The c-statistics (95% confidence interval) were similar in the full validation sample and the 2 subsamples: 0.69 (0.65-0.73), 0.69 (0.63-0.74), and 0.68 (0.63-0.74), respectively. Calibration was good (slope b and intercept close to 1 and 0, respectively, and nonsignificance in the Hosmer-Lemeshow goodness-of-fit test). The validated model based on 6 clinical factors reliably identifies risk for CPSP risk in about 70% of patients undergoing the surgeries studied, allowing surgeons and anesthesiologists to plan and initiate risk-reduction strategies in routine practice and researchers to screen for risk when randomizing patients in trials.
目前尚无针对慢性术后疼痛（CPSP）的外部验证术前风险评分。我们测试了一个从四个手术环境中的 2929 名患者前瞻性队列中开发的 CPSP 六因素风险模型的通用性。17 个中心招募了 1225 名计划接受腹股沟疝修补术、子宫切除术（阴道或腹部）或开胸术的患者。6 个临床预测因子是手术程序、年龄较小、身体健康（简短健康调查-12）、心理健康（简短健康调查-12）、手术部位的术前疼痛和另一部位的术前疼痛。通过 4 个月的体格检查确认慢性术后疼痛。使用全队列和 2 个亚组（历史和新中心）计算模型的区分度（c 统计量）、校准和诊断准确性（敏感性、特异性、阳性和阴性似然比），以评估地理和时间的可转移性。排除和丢失后的数据包括 1088 名患者；20.6%的患者在 4 个月时出现 CPSP。全验证样本和 2 个亚组的 c 统计量（95%置信区间）相似：0.69（0.65-0.73）、0.69（0.63-0.74）和 0.68（0.63-0.74）。校准良好（斜率 b 和截距分别接近 1 和 0，Hosmer-Lemeshow 拟合优度检验无显著性）。基于 6 个临床因素的验证模型可在接受研究手术的约 70%的患者中可靠地识别 CPSP 风险，使外科医生和麻醉师能够在常规实践中计划和启动降低风险策略，并使研究人员在试验中对患者进行随机分组时筛选风险。
