Presurgical risk model for chronic postsurgical pain based on 6 clinical predictors: a prospective external validation
Presurgical risk model for chronic postsurgical pain based on 6 clinical predictors: a prospective external validation
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DOI：
10.1097/j.pain.0000000000001945
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发表时间：
2020-11-01
期刊：
影响因子：
7.4
通讯作者：
Sabate, Sergi
中科院分区：
文献类型：
--
作者：
Montes, Antonio;Roca, Gisela;Sabate, Sergi
目前尚无外部验证的慢性术后疼痛（CPSP）的术前风险评分。我们测试了CPSP的六因素风险模型的普遍性，该模型是从4种手术环境中的2929例患者的前瞻性队列中开发的。17家中心入组了1225例计划行腹股沟疝修补术、子宫切除术（经阴道或经腹）或开胸术的患者。6个临床预测因素为手术操作、年轻、身体健康（简表健康调查-12）、心理健康（简表健康调查-12）、术前术野疼痛和术前其他区域疼痛。慢性术后疼痛在4个月时通过体格检查确认。计算模型的区分度（c-统计量）、校准和诊断准确性（灵敏度、特异性和阳性和阴性似然比），以评估全队列和2个子样本（历史和新中心）的地理和时间可转移性。排除和丢失后的完整数据集包括1088例患者; 20.6%在4个月时发生CPSP。全验证样本和2个子样本的c-统计量（95%置信区间）相似：分别为0.69（0.65-0.73）、0.69（0.63-0.74）和0.68（0.63-0.74）。校准良好（斜率B和截距分别接近1和0，在Hosmer-Lemeshow拟合优度检验中无显著性）。基于6个临床因素的验证模型可靠地识别了约70%接受研究手术的患者的CPSP风险，允许外科医生和麻醉师在常规实践中计划和启动风险降低策略，研究人员在试验中随机分配患者时筛选风险。
No externally validated presurgical risk score for chronic postsurgical pain (CPSP) is currently available. We tested the generalizability of a six-factor risk model for CPSP developed from a prospective cohort of 2929 patients in 4 surgical settings. Seventeen centers enrolled 1225 patients scheduled for inguinal hernia repair, hysterectomy (vaginal or abdominal), or thoracotomy. The 6 clinical predictors were surgical procedure, younger age, physical health (Short Form Health Survey-12), mental health (Short Form Health Survey-12), preoperative pain in the surgical field, and preoperative pain in another area. Chronic postsurgical pain was confirmed by physical examination at 4 months. The model's discrimination (c-statistic), calibration, and diagnostic accuracy (sensitivity, specificity, and positive and negative likelihood ratios) were calculated to assess geographic and temporal transportability in the full cohort and 2 subsamples (historical and new centers). The full data set after exclusions and losses included 1088 patients; 20.6% had developed CPSP at 4 months. The c-statistics (95% confidence interval) were similar in the full validation sample and the 2 subsamples: 0.69 (0.65-0.73), 0.69 (0.63-0.74), and 0.68 (0.63-0.74), respectively. Calibration was good (slope b and intercept close to 1 and 0, respectively, and nonsignificance in the Hosmer-Lemeshow goodness-of-fit test). The validated model based on 6 clinical factors reliably identifies risk for CPSP risk in about 70% of patients undergoing the surgeries studied, allowing surgeons and anesthesiologists to plan and initiate risk-reduction strategies in routine practice and researchers to screen for risk when randomizing patients in trials.