Schroeder Michelle N, Wu Jennifer M, Margulies Samantha L, Willis-Gray Marcella G
Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Int Urogynecol J. 2023 Oct;34(10):2415-2420. doi: 10.1007/s00192-023-05547-9. Epub 2023 May 5.
Patient-Reported Outcome Measurement Information System (PROMIS) questionnaires provide valid comparisons across disciplines. Pain measures can be used to track functional outcomes. Limited PROMIS pain data exist in gynecological surgery. We sought to use pain intensity and pain interference short forms to assess pain and recovery after pelvic organ prolapse surgery.
The PROMIS pain intensity and pain interference questionnaires were given to patients undergoing uterosacral ligament suspension (USLS), sacrospinous ligament fixation (SSLF) or minimally invasive sacrocolpopexy (MISC) at baseline, 1 week, and 6 weeks postoperatively. Clinical minimally important change was defined as a difference of 2-6 T-score points. Mean pain intensity and pain interference T-scores were compared at baseline, 1 week and 6 weeks with ANOVA. Multiple linear regression assessed 1-week scores adjusted for apical suspension type, advanced prolapse, concurrent hysterectomy, concurrent anterior or posterior repair, and concurrent sling.
At 1 week, all apical suspension groups showed minimally important change in pain intensity and pain interference T-scores. Between groups at 1 week, pain interference was higher in USLS (66.3±6.6) and MISC (65.5±5.9) than in SSLF (59.2±9.8), p=0.01. Multiple linear regression showed an association of hysterectomy with increases in pain intensity and pain interference. USLS had a higher proportion of concurrent hysterectomy (100%) than SSLF (0%) and MISC (30.8%), p<0.01. No difference was found based on apical suspension type alone.
No differences were found in PROMIS pain intensity and pain at 1 week postoperatively after apical suspension procedures.
患者报告结局测量信息系统（PROMIS）问卷可在不同学科间进行有效的比较。疼痛测量可用于追踪功能结局。妇科手术中PROMIS疼痛数据有限。我们试图使用疼痛强度和疼痛干扰简表来评估盆腔器官脱垂手术后的疼痛及恢复情况。
在基线、术后1周和6周时，向接受子宫骶骨韧带悬吊术（USLS）、骶棘韧带固定术（SSLF）或微创骶骨阴道固定术（MISC）的患者发放PROMIS疼痛强度和疼痛干扰问卷。临床最小重要变化定义为T评分相差2 - 6分。采用方差分析比较基线、1周和6周时的平均疼痛强度和疼痛干扰T评分。多元线性回归评估了经顶端悬吊类型、重度脱垂、同期子宫切除术、同期前后壁修补术和同期吊带术校正后的1周评分。
在术后1周时，所有顶端悬吊组的疼痛强度和疼痛干扰T评分均显示出最小重要变化。术后1周时，USLS组（66.3±6.6）和MISC组（65.5±5.9）的疼痛干扰高于SSLF组（59.2±9.8），p = 0.01。多元线性回归显示子宫切除术与疼痛强度及疼痛干扰增加有关。USLS同期子宫切除术的比例（100%）高于SSLF组（0%）和MISC组（30.8%），p < 0.01。仅基于顶端悬吊类型未发现差异。
顶端悬吊手术后1周，PROMIS疼痛强度和疼痛方面未发现差异。
