Editorial. Postoperative pain control after spinal surgery: an opportunity

Ghogawala, Zoher

doi:10.3171/2020.6.spine20803

Cited by 1 publication

(1 citation statement)

References 4 publications

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“…23 The incorporation of the CAPPS score in future ERAS programs for spinal surgery may lead to an individualized approach in the prevention and management of postoperative pain leading to improved patient recovery and reduction in overall surgical stress. [23][24][25] This paradigm shift in management could lead to improvements in postoperative pain intensity and patient satisfaction, and a reduction in postoperative opioid use and other pain-related complications such as the development of persistent postsurgical pain.…”

Section: Discussionmentioning

confidence: 99%

Validation of the Calgary Postoperative Pain after Spine Surgery Score for Poor Postoperative Pain Control after Spine Surgery

Yang

Riva-Cambrin

Cunningham

et al. 2022

Can. J. Neurol. Sci.

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Objective: The Calgary Postoperative Pain after Spine Surgery (CAPPS) score was developed to identify patients at risk of experiencing poorly controlled pain after spine surgery. The goal of this study was to independently validate the CAPPS score on a prospectively collected patient sample. Methods: Poor postoperative pain control was defined as a mean numeric rating scale (NRS) for pain >4 at rest in the first 24 hours after surgery. Baseline characteristics in this study (validation cohort) were compared to those of the development cohort used to create the CAPPS score. Predictive performance of the CAPPS score was assessed by the area under the curve (AUC) and percentage misclassification for discrimination. A graphical comparison between predicted probability vs. observed incidence of poorly controlled pain was performed for calibration. Results: Fifty-two percent of 201 patients experienced poorly controlled pain. The validation cohort exhibited lower depression scores and a higher proportion using daily opioid medications compared to the development cohort. The AUC was 0.74 [95%CI = 0.68–0.81] in the validation cohort compared to 0.73 [95%CI = 0.69–0.76] in the development cohort for the eight-tier CAPPS score. When stratified between the low- vs. extreme-risk and low- vs. high-risk groups, the percentage misclassification was 21.2% and 30.7% in the validation cohort, compared to 29.9% and 38.0% in the development cohort, respectively. The predicted probability closely mirrored the observed incidence of poor pain control across all scores. Conclusions: The CAPPS score, based on seven easily obtained and reliable prognostic variables, was validated using a prospectively collected, independent sample of patients.

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