Department of Anesthesiology, The Second Hospital of Lanzhou University, Lanzhou, Gansu, 730030, China.
Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510000, China.
BMC Womens Health. 2024 Oct 29;24(1):583. doi: 10.1186/s12905-024-03430-3.
Postoperative pain (PP) is a dynamic process that reflects the complex interplay between symptoms, treatment, and patient experiences, and its intensity is reportedly primarily related to the severity of surgical trauma. However, no large-scale national database-based study has hitherto been conducted to assess the occurrence and features related to PP following breast cancer (BC) surgery.
In this retrospective analysis, we screened BC surgery cases between 2015 and 2019 within the National Inpatient Sample (NIS) Database, utilizing the International Classification of Diseases (ICD) 10th edition clinical modification codes. The researchers identified patients who developed PP and compared them to those who did not. Factors associated with PP were then screened: patient demographics (age and race), hospital characteristics (type of insurance, bed size, teaching status, type of admission, location, and hospital area), length of stay (LOS), total cost during hospitalization, inpatient mortality, comorbidities, and perioperative complications. Data were analyzed using descriptive statistics. Multivariate logistic regression analysis was used to determine the independent risk factors for postoperative pain in BC surgery.
39,870 BC surgery cases were identified over a five-year period from 2015 to 2019. The overall occurrence of PP following breast cancer surgery was 6.15% (2,387 cases), with a slight upward trend every year. Significant racial disparities were observed, Whites associated with a higher incidence of PP (P < 0.001). In addition, the incidence of elective admission was 11.96% lower (67.491% vs. 79.451%) than that of patients without PP following breast cancer surgery (P < 0.001). Besides, PP was related to prolonged hospitalization duration (3 vs. 2 days; P < 0.001), and higher total cost ($68,283 vs. $60,036; P < 0.001). Multivariate logistic regression identified breast cancer surgery-independent risk factors for PP, including younger age, non-elective hospital admission, rural hospitals, depression, drug abuse, metastatic cancer, psychoses, weight loss, and chronic pulmonary disease. In addition, postoperative pain for BC was associated with urinary retention, gastrointestinal complications, continuous invasive ventilation, deep vein thrombosis, urinary tract infection, blood transfusion, arrhythmia, and chest pain.
Despite the low incidence of postoperative pain in BC surgery cases, it is essential to investigate factors predisposing to PP to allow optimal care management and improve the outcomes of this patient population.
术后疼痛（PP）是一个动态的过程，反映了症状、治疗和患者体验之间的复杂相互作用，其强度主要与手术创伤的严重程度有关。然而，迄今为止，尚无基于大规模国家数据库的研究来评估乳腺癌（BC）手术后疼痛的发生和相关特征。
在这项回顾性分析中，我们利用国际疾病分类（ICD）第 10 版临床修订版代码，从国家住院患者样本（NIS）数据库中筛选了 2015 年至 2019 年间的 BC 手术病例。研究人员确定了发生 PP 的患者，并将其与未发生 PP 的患者进行了比较。然后筛选与 PP 相关的因素：患者人口统计学特征（年龄和种族）、医院特征（保险类型、床位规模、教学状态、入院类型、位置和医院区域）、住院时间（LOS）、住院期间总费用、住院死亡率、合并症和围手术期并发症。使用描述性统计分析数据。多变量逻辑回归分析用于确定 BC 手术中术后疼痛的独立危险因素。
在 2015 年至 2019 年的五年期间，确定了 39870 例 BC 手术病例。乳腺癌手术后出现 PP 的总体发生率为 6.15%（2387 例），呈逐年略有上升趋势。观察到显著的种族差异，白人发生 PP 的比例较高（P<0.001）。此外，与无 PP 的乳腺癌手术患者相比，择期入院的发生率降低了 11.96%（67.491%比 79.451%）（P<0.001）。此外，PP 与住院时间延长（3 天比 2 天；P<0.001）和总费用增加（68283 美元比 60036 美元；P<0.001）有关。多变量逻辑回归确定了与 BC 手术无关的 PP 独立危险因素，包括年龄较小、非择期住院、农村医院、抑郁、药物滥用、转移性癌症、精神病、体重减轻和慢性肺部疾病。此外，BC 的术后疼痛与尿潴留、胃肠道并发症、持续有创通气、深静脉血栓形成、尿路感染、输血、心律失常和胸痛有关。
尽管 BC 手术中术后疼痛的发生率较低，但仍需调查导致 PP 的因素，以便进行最佳的护理管理，并改善该患者人群的结局。
