Department of Orthopedic Surgery, University of California, 2550 23rd Street, San Francisco, CA, 94110, USA.
Department of Bioengineering and Therapeutic Sciences, School of Pharmacy, University of California, San Francisco, CA, USA.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):569-576. doi: 10.1007/s00590-023-03670-3. Epub 2023 Aug 31.
Poor pain alleviation (PPA) after orthopaedic surgery is known to increase recovery time, readmissions, patient dissatisfaction, and lead to chronic postsurgical pain. This study's goal was to identify the magnitude of PPA and its risk factors in the orthopaedic trauma patient population.
A single-institution's electronic medical records from 2015 to 2018 were available for retrospective analysis. Inclusion criteria included orthopaedic fracture surgery patients admitted to the hospital for 24 h or more. Collected variables included surgery type, basic demographics, comorbidities, inpatient medications, pain scores, and length of stay. PPA was defined as a pain score of ≥ 8 on at least three occasions 4-12 h apart. Associations between collected variables and PPA were derived using a multivariable logistic regression model and expressed in adjusted odds ratios.
A total of 1663 patients underwent fracture surgeries from 2015 to 2018, and 25% of them reported PPA. Female sex, previous use of narcotics, increased ASA, increased baseline pain score, and younger age without comorbidities were identified as significant risk factors for PPA. Spine procedures were associated with increased risk of PPA, while procedures in the hip, shoulder, and knee had reduced risk. Patients experiencing PPA were less likely to receive NSAIDs compared to other pain medications.
This study found an unacceptably high rate of PPA after fracture surgery. While the identified risk factors for PPA were all non-modifiable, our results highlight the necessity to improve application of current multimodal approaches to pain alleviation including a more personalized approach to pain alleviation.
众所周知，骨科手术后疼痛缓解不佳（PPA）会延长康复时间、增加再入院率、降低患者满意度，并导致慢性术后疼痛。本研究旨在确定骨科创伤患者人群中 PPA 的程度及其危险因素。
对 2015 年至 2018 年某单一机构的电子病历进行回顾性分析。纳入标准包括接受骨科骨折手术且住院时间超过 24 小时的患者。收集的变量包括手术类型、基本人口统计学资料、合并症、住院期间用药、疼痛评分和住院时间。PPA 定义为至少三次 4-12 小时间隔疼痛评分≥8。使用多变量逻辑回归模型得出收集变量与 PPA 之间的关联，并以调整后的优势比表示。
2015 年至 2018 年期间共有 1663 名患者接受了骨折手术，其中 25%的患者报告存在 PPA。女性、既往使用阿片类药物、增加 ASA、增加基线疼痛评分以及无合并症的年轻患者被确定为 PPA 的显著危险因素。脊柱手术与 PPA 的风险增加相关，而髋部、肩部和膝关节手术则降低了 PPA 的风险。与其他止痛药相比，经历 PPA 的患者接受 NSAIDs 的可能性较小。
本研究发现骨折手术后 PPA 的发生率高得令人无法接受。虽然确定的 PPA 危险因素均不可改变，但我们的结果强调了有必要改进当前多模式疼痛缓解方法的应用，包括采用更个性化的疼痛缓解方法。
