Department of Medicine, University of Montreal, Montreal, Quebec, Canada; University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Outcomes Research Consortium, Cleveland, Ohio; Perioperative Outcomes and Informatics Collaborative, Winston-Salem, North Carolina.
Anesthesiology. 2024 Aug 1;141(2):286-299. doi: 10.1097/ALN.0000000000005030.
The amount of same-day surgery has increased markedly worldwide in recent decades, but there remains limited evidence on chronic postsurgical pain in this setting.
This study assessed pain 90 days after ambulatory surgery in an international, multicenter prospective cohort study of patients at least 45 yr old with comorbidities or at least 65 yr old. Pain was assessed using the Brief Pain Inventory. Chronic postsurgical pain was defined as a change of more than 1 point in self-rated average pain at the surgical site between baseline and 90 days, and moderate to severe chronic postsurgical pain was defined as a score greater than 4 in self-rated average pain at the surgical site at 90 days. Risk factors for chronic postsurgical pain were identified using multivariable logistic regression.
Between November 2021 and January 2023, a total of 2,054 participants were included, and chronic postsurgical pain occurred in 12% of participants, of whom 93.1% had new chronic pain at the surgical site (i.e., participants without pain before surgery). Moderate to severe chronic postsurgical pain occurred in 9% of overall participants. Factors associated with chronic postsurgical pain were active smoking (odds ratio, 1.82; 95% CI, 1.20 to 2.76), orthopedic surgery (odds ratio, 4.7; 95% CI, 2.24 to 9.7), plastic surgery (odds ratio, 4.3; 95% CI, 1.97 to 9.2), breast surgery (odds ratio, 2.74; 95% CI, 1.29 to 5.8), vascular surgery (odds ratio, 2.71; 95% CI, 1.09 to 6.7), and ethnicity (i.e., for Hispanic/Latino ethnicity, odds ratio, 3.41; 95% CI, 1.68 to 6.9 and for First Nations/native persons, odds ratio, 4.0; 95% CI, 1.05 to 15.4).
Persistent postsurgical pain after same-day surgery is common, is usually moderate to severe in nature, and occurs mostly in patients without chronic pain before surgery.
近几十年来，全球范围内的日间手术量显著增加，但在这种情况下，关于慢性术后疼痛的证据仍然有限。
本研究在一项国际性、多中心前瞻性队列研究中评估了至少 45 岁合并症或至少 65 岁患者行日间手术后 90 天的疼痛情况。使用简明疼痛量表评估疼痛。慢性术后疼痛定义为基线至 90 天之间手术部位自我评估平均疼痛评分增加超过 1 分，中度至重度慢性术后疼痛定义为 90 天时手术部位自我评估平均疼痛评分大于 4 分。使用多变量逻辑回归确定慢性术后疼痛的危险因素。
2021 年 11 月至 2023 年 1 月期间，共纳入 2054 名参与者，12%的参与者发生慢性术后疼痛，其中 93.1%的参与者在手术部位出现新的慢性疼痛（即术前无疼痛的参与者）。9%的总体参与者发生中重度慢性术后疼痛。与慢性术后疼痛相关的因素包括：吸烟（比值比，1.82；95%置信区间，1.20 至 2.76）、骨科手术（比值比，4.7；95%置信区间，2.24 至 9.7）、整形手术（比值比，4.3；95%置信区间，1.97 至 9.2）、乳房手术（比值比，2.74；95%置信区间，1.29 至 5.8）、血管手术（比值比，2.71；95%置信区间，1.09 至 6.7）和种族（即，西班牙裔/拉丁裔，比值比，3.41；95%置信区间，1.68 至 6.9；以及第一民族/原住民，比值比，4.0；95%置信区间，1.05 至 15.4）。
日间手术后持续的术后疼痛很常见，通常为中重度，且主要发生在术前无慢性疼痛的患者中。
