Development and Validation of a Prediction Model for Chronic Post-Surgical Pain After Thoracic Surgery in Elderly Patients: A Retrospective Cohort Study

Abstract

Purpose Chronic post-surgical pain (CPSP) is one of the adverse outcomes after surgery, especially in thoracotomy. However, the prevalence of CPSP in elderly adults (≥65 years), is still limited. Therefore, the present study was undertaken to establish and validate the prediction model of CPSP in those patients after thoracic surgery, including thoracotomy and video-assisted thoracoscopic surgery. Patients and Methods This retrospective, observational single-center cohort study was conducted in Nanfang Hospital, Southern Medical University, which randomly and consecutively collected 577 elderly patients who underwent thoracic surgery between January 1, 2017, and December 31, 2020. According to the Akaike information criterion, the prediction model was built based on all the data and was validated by calibration with 500 bootstrap samples. Results The mean age of participants was 69.09±3.80 years old, and 63.1% were male. The prevalence of CPSP was 26.9%. Age more than 75 years, BMI, blood loss, longer length of hospital stays, and higher pre-operative neutrophil count were associated with CPSP. Except for these factors, we incorporated history of drinking to build up the prediction model. The areas under the curve (AUCs) of the prediction models were 0.66 (95% CI, 0.61–0.71) and 0.64 (95% CI, 0.59–0.69) in the observational and validation cohorts, respectively. And the calibration curve of the predictive model showed a good fit between the predicted risk of CPSP and observed outcomes in elderly patients. Conclusion The present developed model may help clinicians to find high-risk elderly patients with CPSP after thoracic surgery and take corresponding measures in advance to reduce the incidence of CPSP and improve their life quality.

Opioid-free anaesthesia reduces postoperative nausea and vomiting after thoracoscopic lung resection: a randomised controlled trial

“…If yes, has the feeling of nausea interfered with activities of daily living?). 31 Secondary outcomes included nausea, retching, vomiting, use of rescue antiemetics, postoperative sufentanil consumption, and need for rescue analgesia during 0e24 h and 24e48 h, NRS pain scores at rest and on coughing at 24 h and 48 h, length of PACU stay, length of postoperative hospital stay, 30-and 90-day postsurgical pain (defined as a NRS pain score !1), 33 and 30-and 90-day mortality. Safety outcomes included hypotension (defined as a reduction in mBP >30% of the baseline value for at least 1 min), bradycardia (defined as HR <50 beats min À1 for at least 1 min), hypertension (defined as an increase in mBP >30% of baseline for at least 1 min), tachycardia (defined as HR >100 beats min À1 for at least 1 min) during anaesthesia and in the PACU, interventions for haemodynamic events (using ephedrine, phenylephrine, atropine, urapidil, or esmolol), sedation in the PACU (defined as MOAA/S scores 3), and the occurrence of headache, dizziness, nightmare, or hallucination within 0e48 h after surgery.…”

Prognostic models for chronic postsurgical pain-Current developments, trends, and challenges

“…Since that, six more models have been identified by us here (2021 to mid-2023, Table 1). While eight models [32,33,29,34–38] used only preoperative factors, three models [39–41] used preoperative and intraoperative factors, seven models [42–48] used preoperative and postoperative factors, and two models [49,30 ▪ ] used pre-, intra- and postoperative factors. Because of the use of heterogeneous diagnostic factors for CPSP, different time periods and different cut-offs (leading to over- or underestimate CPSP predictors), it is difficult to compare the individual models so far ([9] and Table 1).…”

“…Some of the identified preoperative factors relevant for the development of CPSP have inconsistent evidence. For example, the prognostic value of BMI for CPSP seems to be high, especially for orthopedic and cardiovascular surgery [48,37 ▪ ]. Overweight and obesity at the population level may be associated with an increase in pain, particularly severe or localized pain [56].…”

“…An experimental study recently showed that the activity of the immune system in the skin and the healing process (based on individual protein signatures) after an incision is associated with such increased sensitization processes [59 ▪▪ ]. The extent to which immune signatures and protein networks [37 ▪ ] play a role in the development of CPSP, how this can be used to improve prognostic models and–at the end–prevent chronification, is the subject of current research.…”