Abstract:Objective To explore the risk factors for moderate to severe pain in the chronic stage after knee arthroscopy and to construct and validate a prediction model.Methods Clinical data were collected from 236 patients who underwent knee arthroscopic surgery at Tangdu Hospital between September 2019 and February 2021.Patients with NRS≥4 points were included in the pain group,and those with NRS<4 points were included in the pain free group according to the numerical rating scale (NRS) for pain at 3 months after surgery.29 patients,including 13 males and 16 females,with a mean age of (62.03±9.52) years were in the postoperative chronic stage pain group and 207 patients,including 114 males and 93 females,with a mean age of (40.00±12.46) years.Multivariate logistic regression analysis was used to compare the independent risk factors for chronic postoperative pain (CPSP) between the two groups.Based on the clinical indexes obtained from screening,a nomogram prediction model was constructed in R language,and bootstrap bootstrap sampling was used for internal validation.The predictive ability of the model was evaluated by receiver operating characteristic (ROC) curve and calibration curve.Results The results of univariate analysis showed that the risk factors for pain in the chronic stage after surgery were age,body mass index (BMI),Outerbridge grade of articular cartilage damage,NRS≥4 points at 72 h after surgery,and having diabetes mellitus or not.In multivariate analysis,advanced age,BMI≥24 kg/m2,Outerbridge grades Ⅲ to Ⅳ,and NRS≥4 points at 72 h postoperatively were independent risk factors for pain in the chronic stage after knee arthroscopy.A nomogram prediction model was constructed based on the results of multivariate analysis,and internal validation showed that the C-index was 0.968,the area under the ROC curve was 0.969,and the predictive results of the calibration curve and the actual observation were in good agreement.Conclusion Advanced age,BMI≥24 kg/m2,Outerbridge grades Ⅲ to Ⅳ,and NRS≥4 points at 72 h after knee arthroscopy are the risk factors for pain in the chronic stage,and the nomogram model constructed based on the above factors has high accuracy and clinical usefulness.
冯重阳,姬振伟,吴鹏,王志学,张智翔,方怀明,丁勇. 膝关节镜术后慢性期疼痛预测模型的构建与验证[J]. 实用骨科杂志, 2022, 28(11): 966-.
Feng Chongyang,Ji Zhenwei,Wu Peng,Wang Zhixue,Zhang Zhixiang,Fang Huaiming,Ding Yong. Construction and Validation of a Pain Prediction Model for the Chronic Stage After Knee Arthroscopy. sygkzz, 2022, 28(11): 966-.
[1]Carr AJ,Price AJ,Glyn-Jones S,et al.Advances in arthroscopy-indications and therapeutic applications[J].Nat Rev Rheumatol,2015,11(2):77-85.
[2]Tornbjerg SM,Nissen N,Englund M,et al.Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery[J].Br J Sports Med,2017,51(6):525-530.
[3]Kim S,Bosque J,Meehan JP,et al.Increase in outpatient knee arthroscopy in the united states:A comparison of national surveys of ambulatory surgery,1996 and 2006[J].J Bone Joint Surg (Am),2011,93(11):994-1000.
[4]Hoofwijk DMN,Fiddelers AAA,Emans PJ,et al.Prevalence and predictive factors of chronic postsurgical pain and global surgical recovery 1 year after outpatient knee arthroscopy:A prospective cohort study[J].Medicine (Baltimore),2015,94(45):e2017.
[5]Lu Y,Hu B,Dai H,et al.Predictors of chronic postsurgical pain in elderly patients undergoing hip arthroplasty:A multi-center retrospective cohort study[J].Int J Gen Med,2021(14):7885-7894.
[6]Slattery C,Kweon CY.Classifications in brief:Outerbridge classification of chondral lesions[J].Clin Orthop Relat Res,2018,476(10):2101-2104.
[7]Kehlet H,Jensen TS,Woolf CJ.Persistent postsurgical pain:Risk factors and prevention[J].Lancet,2006,367(9522):1618-1625.
[8]Jochimsen KN,Noehren B,Mattacola CG,et al.Preoperative psychosocial factors and short-term pain and functional recovery after hip arthroscopy for femoroacetabular impingement syndrome[J].J Athl Train,2021,56(10):1064-1071.
[9]Gerbershagen HJ,Dagtekin O,Rothe T,et al.Risk factors for acute and chronic postoperative pain in patients with benign and malignant renal disease after nephrectomy[J].Eur J Pain,2009,13(8):853-860.
[10]Perkins FM,Kehlet H.Chronic pain as an outcome of surgery.A review of predictive factors[J].Anesthesiology,2000,93(4):1123-1133.
[11]Hajian-Tilaki K.The choice of methods in determining the optimal cut-off value for quantitative diagnostic test evaluation[J].Stat Methods Med Res,2018,27(8):2374-2383.
[12]Hagino T,Ochiai S,Watanabe Y,et al.Complications after arthroscopic knee surgery[J].Arch Orthop Trauma Surg,2014,134(11):1561-1564.
[13]Rougereau G,Kavakelis T,Sailhan F,et al.Postoperative pain and infection are the most frequent reasons for legal action after knee arthroscopy:A 5-year review based on two private insurance French companies after arthroscopy[J].Knee Surg Sports Traumatol Arthrosc,2021,29(11):3551-3559.
[14]Aternali A,Slepian PM,Clarke H,et al.Presurgical distress about bodily sensations predicts chronic postsurgical pain intensity and disability 6 months after cardiothoracic surgery[J].Pain,2022,163(1):159-169.
[15]Palazzo C,Nguyen C,Lefevre-Colau MM,et al.Risk factors and burden of osteoarthritis[J].Ann Phys Rehabil Med,2016,59(3):134-138.
[16]Sihvonen R,Paavola M,Malmivaara A,et al.Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear[J].N Engl J Med,2013,369(26):2515-2524.
[17]Sihvonen R,Paavola M,Malmivaara A,et al.Arthroscopic partial meniscectomy versus placebo surgery for a degenerative meniscus tear:A 2-year follow-up of the randomised controlled trial[J].Ann Rheum Dis,2018,77(2):188-195.
[18]Lubowitz JH.A controlled trial of arthroscopic surgery for osteoarthritis of the knee[J].Arthroscopy,2002,18(8):950-951.
[19]Prosser R,Hancock MJ,Nicholson LL,et al.Prognosis and prognostic factors for patients with persistent wrist pain who proceed to wrist arthroscopy[J].J Hand Ther,2012,25(3):264-269;270.
[20]Gabriel RA,Burton BN,Ingrande J,et al.The association of body mass index with same-day hospital admission,postoperative complications,and 30-day readmission following day-case eligible joint arthroscopy:A national registry analysis[J].J Clin Anesth,2020(59):26-31.
[21]Harrison MM,Morrell J,Hopman WM.Influence of obesity on outcome after knee arthroscopy[J].Arthroscopy,2004,20(7):691-695.
[22]Forlenza EM,Lavoie-Gagne O,Lu Y,et al.Preoperative opioid use predicts prolonged postoperative opioid use and inferior patient outcomes following anterior cruciate ligament reconstruction[J].Arthroscopy,2020,36(10):2681-2688.
[23]Westermann RW.Editorial commentary:Scoping knees with osteoarthritis and opioid dependence?Brace yourself for postop pain[J].Arthroscopy,2019,35(2):581-582.
[24]Bohnsack M,Lipka W,Rühmann O,et al.The value of knee arthroscopy in patients with severe radiological osteoarthritis[J].Arch Orthop Trauma Surg,2002,122(8):451-453.
[25]Horn A,Kaneshiro K,Tsui BCH.Preemptive and preventive pain psychoeducation and its potential application as a multimodal perioperative pain control option:A systematic review[J].Anesth Analg,2020,130(3):559-573.
[26]Gulur P,Nelli A.Persistent postoperative pain:Mechanisms and modulators[J].Curr Opin Anaesthesiol,2019,32(5):668-673.
[27]Arboleda MF,GirónArango L,Peng PWH.Can recent chronic pain techniques help with acute perioperative pain?[J].Curr Opin Anaesthesiol,2019,32(5):661-667.
[28]Zhou H,Zhang Y,Qiu Z,et al.Nomogram to predict cause-specific mortality in patients with surgically resected stage I Non-Small-Cell lung cancer:A competing risk analysis[J].Clin Lung Cancer,2018,19(2):e195-e203.