Perioperative Medicine, Barts Heart Centre and St. Bartholomew's Hospital, London, UK.
William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, UK.
Eur J Pain. 2021 Sep;25(8):1829-1838. doi: 10.1002/ejp.1794. Epub 2021 Jun 13.
Our aim was to describe the long-term prevalence, risk factors and impact on quality of life of persistent postsurgical pain (PPP) following cardiac surgery.
All patients undergoing sternotomy in a single centre over 6 months were prospectively interviewed by telephone at six months and seven years following surgery.
We analysed data from 174 patients at six months and 146 patients at seven years following surgery, revealing a PPP prevalence of 39.7% (n = 69) and 9.6% (n = 14) respectively. At six post-operative months, younger age, higher acute pain score, intraoperative remifentanil infusion and more prolonged surgery were associated with sternotomy-site PPP. These variables, in combination, predict PPP in this study group with area under the receiver operating curve of 0.91 (95% CI 0.86-0.94) at 6 months and 0.74 (95% CI 0.57-0.86) at 7 years. Quality of life scores were significantly lower with PPP (median change in EQ-5D score = -0.23 [-0.57, -0.09] compared to 0.00 [0-0.24] without PPP at 7 years, p < 0.001). At7 years, younger age, prolonged surgery and intraoperative remifentanil infusion were associated with sternotomy-site PPP.
To the best of our knowledge, this is the longest follow-up of PPP across all surgical specialities and certainly within cardiac surgery. Prevalence of PPP and impact on QOL after cardiac surgery are high and associated with young age, high acute pain score, use of remifentanil and long operative time. We present a predictive score to highlight patients at risk of developing PPP.
Seven years after cardiac surgery, almost 10% of patients in this cohort described persistent pain in and around the incision. While higher than previous reports in the literature (limited to up to five post-operative years), this assessment was made following three maximal coughs and therefore is movement or function evoked. High incident of persistent postsurgical pain may adversely affect long-term quality of life which is measured using a validated tool.
我们旨在描述心脏手术后持续性手术后疼痛（PPP）的长期患病率、风险因素及其对生活质量的影响。
在 6 个月的时间内，对在单一中心接受胸骨切开术的所有患者进行前瞻性电话访谈，分别在手术后 6 个月和 7 年进行。
我们分析了手术后 6 个月和 7 年的 174 名患者和 146 名患者的数据，结果显示 PPP 的患病率分别为 39.7%（n=69）和 9.6%（n=14）。术后 6 个月时，年龄较小、急性疼痛评分较高、术中瑞芬太尼输注和手术时间较长与胸骨切开部位 PPP 相关。这些变量结合起来，可以预测本研究组的 PPP，在术后 6 个月时的受试者工作特征曲线下面积为 0.91（95%CI 0.86-0.94），7 年后为 0.74（95%CI 0.57-0.86）。有 PPP 的患者生活质量评分明显较低（7 年时 EQ-5D 评分的中位数变化为-0.23[0.57，-0.09]，而无 PPP 的患者为 0.00[0-0.24]，p<0.001）。7 年后，年龄较小、手术时间延长和术中瑞芬太尼输注与胸骨切开部位 PPP 相关。
据我们所知，这是所有外科专业中 PPP 随访时间最长的一次，当然也是心脏外科手术中随访时间最长的一次。心脏手术后 PPP 的患病率和对 QOL 的影响都很高，与年龄较小、急性疼痛评分较高、使用瑞芬太尼和手术时间较长有关。我们提出了一个预测评分，以突出有发生 PPP 风险的患者。
在心脏手术后 7 年，该队列中有近 10%的患者描述了切口周围的持续性疼痛。虽然高于文献中的先前报告（仅限于术后 5 年），但这是在进行了三次最大咳嗽后进行的评估，因此是运动或功能诱发的。持续性手术后疼痛的高发可能会对使用有效工具测量的长期生活质量产生不利影响。
