Wu Xiao-Dan, Zeng Fan-Fang, Yu Xiao-Xuan, Yang Pan-Pan, Wu Jun-Peng, Xv Ping, Wang Hai-Tang, Pei You-Ming
Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, People's Republic of China.
Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510280, People's Republic of China.
J Pain Res. 2022 Sep 29;15:3079-3091. doi: 10.2147/JPR.S368295. eCollection 2022.
Chronic post-surgical pain (CPSP) is one of the adverse outcomes after surgery, especially in thoracotomy. However, the prevalence of CPSP in elderly adults (≥65 years), is still limited. Therefore, the present study was undertaken to establish and validate the prediction model of CPSP in those patients after thoracic surgery, including thoracotomy and video-assisted thoracoscopic surgery.
This retrospective, observational single-center cohort study was conducted in Nanfang Hospital, Southern Medical University, which randomly and consecutively collected 577 elderly patients who underwent thoracic surgery between January 1, 2017, and December 31, 2020. According to the Akaike information criterion, the prediction model was built based on all the data and was validated by calibration with 500 bootstrap samples.
The mean age of participants was 69.09±3.80 years old, and 63.1% were male. The prevalence of CPSP was 26.9%. Age more than 75 years, BMI, blood loss, longer length of hospital stays, and higher pre-operative neutrophil count were associated with CPSP. Except for these factors, we incorporated history of drinking to build up the prediction model. The areas under the curve (AUCs) of the prediction models were 0.66 (95% CI, 0.61-0.71) and 0.64 (95% CI, 0.59-0.69) in the observational and validation cohorts, respectively. And the calibration curve of the predictive model showed a good fit between the predicted risk of CPSP and observed outcomes in elderly patients.
The present developed model may help clinicians to find high-risk elderly patients with CPSP after thoracic surgery and take corresponding measures in advance to reduce the incidence of CPSP and improve their life quality.
慢性术后疼痛（CPSP）是手术后的不良后果之一，尤其是在开胸手术后。然而，老年成年人（≥65岁）中CPSP的患病率仍然有限。因此，本研究旨在建立并验证胸外科手术后（包括开胸手术和电视辅助胸腔镜手术）这些患者的CPSP预测模型。
本回顾性、观察性单中心队列研究在南方医科大学南方医院进行，随机连续收集了2017年1月1日至2020年12月31日期间接受胸外科手术的577例老年患者。根据赤池信息准则，基于所有数据建立预测模型，并通过500个自助抽样样本进行校准验证。
参与者的平均年龄为69.09±3.80岁，男性占63.1%。CPSP的患病率为26.9%。年龄超过75岁、体重指数、失血量、住院时间延长和术前中性粒细胞计数较高与CPSP相关。除这些因素外，我们纳入饮酒史来建立预测模型。预测模型在观察队列和验证队列中的曲线下面积（AUC）分别为0.66（95%CI，0.61 - 0.71）和0.64（95%CI，0.59 - 0.69）。预测模型的校准曲线显示，老年患者CPSP的预测风险与观察结果之间具有良好的拟合度。
目前建立的模型可能有助于临床医生发现胸外科手术后有CPSP风险的老年高危患者，并提前采取相应措施以降低CPSP的发生率，提高他们的生活质量。
