目的:腹部内脏手术后的慢性术后疼痛(CPSP)是一种被低估的长期并发症,对健康相关生活质量和社会经济成本有相关影响。早期识别受影响的患者很重要。我们旨在确定该患者人群中CPSP的发生率和危险因素。
方法:回顾性病例对照匹配分析,包括2016年至2019年在我院进行内脏手术后诊断为CPSP的所有患者。一对二病例对照匹配基于手术类别(HPB,上消化道,结直肠,移植,减肥,疝气和其他)和手术日期。使用条件多变量逻辑回归确定CPSP的潜在危险因素。
结果:在3730名患者中,176(4.7%)在研究期间被诊断为CPSP,并与352名对照患者的样本相匹配。CPSP的独立危险因素是55岁以下(OR2.64,CI1.51-4.61),先前存在的任何来源的慢性疼痛(OR3.42,CI1.75-6.67),既往腹部手术(OR1.99,CI1.11-3.57),急性术后疼痛(OR1.29,CI1.16-1.44),术后使用非甾体抗炎药(OR3.73,OR1.61-8.65),出院时使用阿片类药物(OR3.78,CI2.10-6.80)和住院时间超过3天(OR2.60,CI1.22-5.53)。术前摄入普瑞巴林是保护性的(OR0.02,CI0.002-0.21)。
结论:CPSP的发生率很高,并且与特定的危险因素有关,其中一些是可以修改的。应特别注意充分治疗先前存在的慢性疼痛和急性术后疼痛。
OBJECTIVE: Chronic postsurgical pain (CPSP) after abdominal visceral surgery is an underestimated long-term complication with relevant impact on health-related quality of life and socioeconomic costs. Early identification of affected patients is important. We aim to identify the incidence and risk factors for CPSP in this patient population.
METHODS: Retrospective case-control matched analysis including all patients diagnosed with CPSP after visceral surgery in our institution between 2016 and 2019. One-to-two case-control matching was based on operation category (HPB, upper-GI, colorectal, transplantation, bariatric, hernia and others) and date of surgery. Potential risk factors for CPSP were identified using conditional multivariate logistic regression.
RESULTS: Among a cohort of 3730 patients, 176 (4.7%) were diagnosed with CPSP during the study period and matched to a sample of 352 control patients. Independent risk factors for CPSP were age under 55 years (OR 2.64, CI 1.51-4.61), preexisting chronic pain of any origin (OR 3.42, CI 1.75-6.67), previous abdominal surgery (OR 1.99, CI 1.11-3.57), acute postoperative pain (OR 1.29, CI 1.16-1.44), postoperative use of non-steroidal anti-inflammatory drugs (OR 3.73, OR 1.61-8.65), opioid use on discharge (OR 3.78, CI 2.10-6.80) and length of stay over 3 days (OR 2.60, CI 1.22-5.53). Preoperative Pregabalin intake was protective (OR 0.02, CI 0.002-0.21).
CONCLUSIONS: The incidence of CPSP is high and associated with specific risk factors, some of them modifiable. Special attention should be given to sufficient treatment of preexisting chronic pain and acute postoperative pain.