疼痛与恢复力对足踝手术结果的影响。
The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes.
作者信息
Hoch Caroline, Pire Jonathan, Scott Daniel J, Gross Christopher E
机构信息
Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA.
出版信息
Foot Ankle Orthop. 2022 Jun 24;7(2):24730114221108137. doi: 10.1177/24730114221108137. eCollection 2022 Apr.
BACKGROUND
Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores.
METHODS
We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months.
RESULTS
BRS weakly correlated with decreased postoperative benzodiazepine use (=.007). PCS magnification (=.050) and helplessness (=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (β=0.334) and benzodiazepine (β=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; =.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities).
CONCLUSION
BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI's strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
背景
恢复力是指在应激事件后恢复的能力，已被证明与手术结果相关。然而，关于患者恢复力对足踝手术结果的影响的研究极少。本研究旨在确定术前恢复力评分对手术结果的预测价值，并研究其与疼痛评分预测价值的比较情况。
方法
我们对2019年11月至2020年11月期间完成术前简易恢复力量表（BRS）并由接受过足踝外科专科培训的外科医生进行手术的成年患者进行了回顾性研究（N = 184）。数据包括人口统计学信息、合并症、手术细节、并发症和再次手术率、术前和术后阿片类药物及苯二氮䓬类药物的使用情况，以及患者报告的其他结局指标（即视觉模拟量表 [VAS]、疼痛灾难化量表 [PCS]、疼痛残疾指数 [PDI]、足踝结局评分 [FAOS] 疼痛子量表）。平均随访时间为4.49（范围1.10 - 14.17）个月。
结果
BRS与术后苯二氮䓬类药物使用减少呈弱相关（r = 0.007）。PCS的放大（r = 0.050）和无助感（r = 0.047）子量表与随访时间延长呈弱相关。PDI总分及大多数子分数与以下至少一项增加显著相关：随访时间、术后阿片类药物或苯二氮䓬类药物的使用。VAS和FAOS疼痛子量表均与任何结局均无相关性。PDI总分是术后阿片类药物（β = 0.334）和苯二氮䓬类药物（β = 0.315）使用的最强预测指标。术前使用阿片类药物的患者PDI总分（使用者 = 39.3，非使用者 = 24.9；P = 0.012）及子分数（即社交活动、性行为、自我护理、生活支持活动）显著更高。
结论
BRS是预测足踝手术结果的不可靠工具，因为它仅与苯二氮䓬类药物使用减少呈弱相关。相反，鉴于本研究中PDI与术后指标的强关联，医生在预测足踝手术患者术后情况时应考虑术前完成PDI的价值。
证据水平
III级，回顾性队列研究。
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