Mainprize Marguerite, Svendrovski Anton, Paasch Christoph, Yilbas Ayse, Katz Joel
From the Department of Surgery, Shouldice Hospital, Ont. (Mainprize, Paasch, Yilbas); the Department of General Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany (Mainprize, Paasch); UZIK Consulting Inc. Toronto, Ont. (Svendrovski); the Department of Psychology, York University, Ont. (Katz)
From the Department of Surgery, Shouldice Hospital, Ont. (Mainprize, Paasch, Yilbas); the Department of General Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany (Mainprize, Paasch); UZIK Consulting Inc. Toronto, Ont. (Svendrovski); the Department of Psychology, York University, Ont. (Katz).
Can J Surg. 2025 Aug 8;68(4):E325-E332. doi: 10.1503/cjs.012824. Print 2025 Jul-Aug.
Sex differences in chronic postsurgical pain have been reported, with the main findings indicating that females experience a greater incidence and severity of pain than males; however, it remains unclear to what these sex differences are attributable. We sought to compare pain and related psychological factors between a matched sample of male and female patients 3 months and 1 year after Shouldice repair.
Male and female participants who underwent Shouldice repair were manually matched 1:1 and compared on 10 variables: age, body mass index, smoking status, preoperative depression and anxiety scores, living status (alone or with others), American Society of Anesthesiologists physical status health classification, preoperative chronic pain, preoperative hernia pain, preoperative pain catastrophizing scores, and nerve handling during surgery. Data on pain were collected from questionnaires administered 3 months and 1 year postoperatively, and data on participant clinical characteristics were collected from operative notes and patient charts.
There were 28 matched male-female pairs at 3 months and 21 at 1 year. The average age preoperatively was 56.18 ± 12.48 years. At 3 months postoperative, 18 females and 6 males had pain ( = 0.001), with females reporting more frequent ( = 0.004) and longer durations ( = 0.005) of pain. The 3-month postoperative Brief Pain Inventory Numeric Rating Scale scores (0-10) showed that in terms of pain severity, females had higher "worst pain" (1.61 ± 1.85 v. 0.32 ± 0.77, = 0.002), "average pain" (0.86 ± 1.08 v. 0.14 ± 0.45, = 0.002), and "pain now" (0.43 ± 1.20 v. 0 ± 0, = 0.010) scores than males. Significant differences were not found in the incidence, severity, frequency, or duration of pain between females and males at 1 year.
After matching on important confounders, sex differences were found in pain frequency, duration, incidence, and severity at 3 months after Shouldice repair. However, by 1 year after surgery the differences were no longer significant.
Clinicaltrials.gov # NCT03986060.
已有报道称慢性术后疼痛存在性别差异，主要研究结果表明女性比男性经历疼痛的发生率和严重程度更高；然而，这些性别差异的原因尚不清楚。我们试图比较Shouldice修补术后3个月和1年时，配对的男性和女性患者之间的疼痛及相关心理因素。
对接受Shouldice修补术的男性和女性参与者进行1:1人工配对，并比较10个变量：年龄、体重指数、吸烟状况、术前抑郁和焦虑评分、生活状况（独居或与他人同住）、美国麻醉医师协会身体状况健康分级、术前慢性疼痛、术前疝气疼痛、术前疼痛灾难化评分以及手术中的神经处理情况。术后3个月和1年时通过问卷调查收集疼痛数据，通过手术记录和患者病历收集参与者临床特征数据。
术后3个月时有28对匹配的男女对，1年时有21对。术前平均年龄为56.18±12.48岁。术后3个月时，18名女性和6名男性有疼痛（P = 0.001），女性报告疼痛更频繁（P = 0.004）且持续时间更长（P = 0.005）。术后3个月的简明疼痛量表数字评分量表（0 - 10）得分显示，在疼痛严重程度方面，女性的“最严重疼痛”（1.61±1.85对0.32±0.77，P = 0.002）、“平均疼痛”（0.86±1.08对0.14±0.45，P = 0.002）和“当前疼痛”（0.43±1.20对0±0，P = 0.010）得分高于男性。术后1年时，女性和男性在疼痛的发生率、严重程度、频率或持续时间方面未发现显著差异。
在对重要混杂因素进行匹配后，发现Shouldice修补术后3个月时，在疼痛频率、持续时间、发生率和严重程度方面存在性别差异。然而，到术后1年时，这些差异不再显著。
Clinicaltrials.gov # NCT03986060。
