Lazaridou Asimina, Brune Daniela, Schneller Tim, George Steven Z, Edwards Robert R, Scheibel Markus
Department for Shoulder and Elbow Surgery, Schulthess Clinic, Zürich, Switzerland.
Department of Anesthesiology, Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Orthop J Sports Med. 2024 Nov 4;12(11):23259671241290223. doi: 10.1177/23259671241290223. eCollection 2024 Nov.
The experience of chronic postsurgical pain (CPSP) can vary widely among patients after rotator cuff repair (RCR).
To determine the prevalence and predictive factors of CPSP at 6 months after RCR.
Cohort study; Level of evidence, 3.
The following assessments were conducted preoperatively and 6 months postoperatively in adult patients with RCR who had undergone primary arthroscopic RCR (N = 1987): Constant score, pain assessed on the numeric rating scale (0-10), the Subjective Shoulder Value, the Oxford Shoulder Score, and quality of life as measured by the EuroQol-5 Dimensions-5 Level (EQ-5D-5L). Patient characteristics-including age, sex, body mass index, and smoking status-and surgical factors-including the duration of surgery and the American Society of Anesthesiologists (ASA) classification-were also reported. Multivariate logistic regression analysis was performed to determine which variables were predictors for CPSP.
The prevalence of moderate to severe preoperative pain in the patients was 30.4% for CPSP. After adjusting for age, surgery duration, ASA classification, sex, and body mass index, results revealed that unique predictors for CPSP were as follows: (1) the presence of preoperative negative affect-assessed using the anxiety/depression dimension of the EQ-5D-5L (odds ratio [OR], 1.46 ( < .001); (2) preoperative pain (OR, 1.17; < .001); and (3) shoulder function (OR, 0.96; < .001). None of the surgical factors appeared to predict CPSP.
Patients predisposed to CPSP can be identified during the preoperative phase. Collectively, there is a call for a more in-depth assessment of biopsychosocial risk factors that could substantially influence the postoperative pain experience.
肩袖修复术（RCR）后，慢性术后疼痛（CPSP）在患者中的体验差异很大。
确定RCR术后6个月时CPSP的患病率及预测因素。
队列研究；证据等级，3级。
对接受初次关节镜下RCR的成年患者（N = 1987）在术前和术后6个月进行以下评估：Constant评分、数字评定量表（0 - 10）评估的疼痛、主观肩关节价值、牛津肩关节评分以及用欧洲五维健康量表（EQ - 5D - 5L）测量的生活质量。还报告了患者特征，包括年龄、性别、体重指数和吸烟状况，以及手术因素，包括手术时长和美国麻醉医师协会（ASA）分级。进行多因素逻辑回归分析以确定哪些变量是CPSP的预测因素。
CPSP患者术前中度至重度疼痛的患病率为30.4%。在调整年龄、手术时长、ASA分级、性别和体重指数后，结果显示CPSP的独特预测因素如下：（1）术前存在负性情绪——用EQ - 5D - 5L的焦虑/抑郁维度评估（比值比[OR]，1.46；P <.001）；（2）术前疼痛（OR，1.17；P <.001）；（3）肩部功能（OR，0.96；P <.001）。没有任何手术因素似乎能预测CPSP。
在术前阶段可以识别出易患CPSP的患者。总体而言，需要对可能极大影响术后疼痛体验的生物心理社会风险因素进行更深入的评估。
