External Validation and Update of the RICP—A Multivariate Model to Predict Chronic Postoperative Pain

Mathes, Tim; Pape-Köhler, Carolina; Moerders, Lena; Lux, Eberhard A.; Neugebauer, Edmund

doi:10.1093/pm/pnx242

Cited by 19 publications

(34 citation statements)

References 29 publications

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“…age) or injury related factors (e.g. complexity of fracture) are not the most important determinants but that pre-existing pain, psychological factors and socioeconomic factors might have a stronger impact, as seen in the literature [15,16]. We neither found clinical important determinants for failure risks and physical functioning with exception to those that generally decrease mobility (obesity and comorbidity) [15].…”

Section: Interpretation Of Results In View Of Other Evidencesupporting

confidence: 41%

“…complexity of fracture) are not the most important determinants but that pre-existing pain, psychological factors and socioeconomic factors might have a stronger impact, as seen in the literature [15,16]. We neither found clinical important determinants for failure risks and physical functioning with exception to those that generally decrease mobility (obesity and comorbidity) [15]. Thus, it appears that it is not very important to consider the effect of these variables on pain and physical functioning in the decision process on the individually appropriate osteosynthesis.…”

Section: Interpretation Of Results In View Of Other Evidencementioning

confidence: 93%

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Factors Predicting Failure of Internal Fixations of Fractures of the Lower Limbs: a Prospective Cohort Study

Prediger

Tjardes

Probst

et al. 2021

Preprint

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BackgroundWe assessed predictive factors of patients with fractures of the lower extremities caused by trauma. We examined which factors might increase failure rates. Furthermore, the predictive factors were set into context with other long-term outcomes, concrete pain and physical functioning.MethodsWe performed a prospective cohort study at a single level I trauma center. We enrolled patients with traumatic fractures of the lower extremities treated with internal fixation from April 2017 to July 2018. We evaluated the following predictive factors: age, gender, diabetes, smoking status, obesity, open fractures and peripheral arterial diseases. The primary outcome was time to failure (nonunion, implant failure or reposition), secondary outcomes were pain and physical functioning measured at follow up 6 months after initial surgery. For the analysis of the primary outcome we used a multivariate stratified (according fracture location) Cox proportional hazard regression model.Results We included 204 patients. Overall, we observed a failure in 33 patients (16.2%). Most of the failures occurred within the first 3 months. Obesity and open fractures increased the risk of failure and decreased physical functioning. None of the predictors had an impact on pain. Age, female gender and smoking of more than ≥ 10 package years increased failure risk numerically but statistical uncertainty was high.Conclusion We found that obesity and open fractures strongly increased the risk of failure. These seem promising candidates to be included in a risk prediction model and can be considered as a good start for clinical decision making across different types of fractures in the lower limb. However, large heterogeneity in the other analyzed factors suggest that for a precise personalized risk estimation, computer-based models incorporating a variety of detailed information (e.g. pattern of injury, x-ray and clinical data) and their interrelation might be needed to increase precision of prediction significantly.Trial registrationNCT03091114

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Section: Interpretation Of Results In View Of Other Evidencesupporting

confidence: 41%

Section: Interpretation Of Results In View Of Other Evidencementioning

confidence: 93%

Factors Predicting Failure of Internal Fixations of Fractures of the Lower Limbs: a Prospective Cohort Study

Prediger

Tjardes

Probst

et al. 2021

Preprint

Self Cite

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“…According to the CPSP de nition from ICD-11, 43.99% (n = 1,033 of 2,348) patients reported characteristics of CPSP after surgery with approximately 14.71% (n = 152 of 1,033) reported moderate to severe pain (NRS > 3). Within those who reported moderate to severe pain, 22.52% (n = 34 of 152) did not take any treatment, 62.25% (n = 94 of 152) relieved their pain by resting or reducing activity, only 15.23% (n = 23 of 152) sought active analgesic therapies (medicine or consultation to doctors).…”

Section: Resultsmentioning

confidence: 99%

Incidence and Risk Factors for Chronic Postsurgical Pain Following Video-assisted Thoracoscopic Surgery: a Retrospective Study

Zhang

Zhou

Hou

et al. 2021

Preprint

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Backgroud: Video-assisted thoracoscopic surgery (VATS) has been widely used as an alternative for thoracotomy, but the reported incidence of chronic postsurgical pain (CPSP) following VATS varied widely. The purpose of this study was to investigate the incidence and risk factors for CPSP after VATS. Methods: We retrospectively collected preoperative demographic, anesthesiology, and surgical factors in a cohort of patients undergoing VATS between January 2018 and October 2020. Patients were interviewed via phone survey for pain intensity, and related medical treatment 3 months after VATS. Univariate and multivariate analysis were used to explore independent risk factors associated with CPSP.Results: 2,348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1,033 of 2,348). Within those suffering CPSP, 14.71% (n = 152 of 1,033) patients reported moderate or severe chronic pain. Only 15.23% (n = 23 of 152) patients with moderate to severe chronic pain sought active analgesic therapies. According to multivariable analysis, age ＜ 65 years (OR 1.278, 95% CI 1.057-1.546, P = 0.011), female (OR 1.597, 95% CI 1.344-1.898, P < 0.001), education level less than junior school (OR 1.295, 95% CI 1.090-1.538, P = 0.003), preoperative pain (OR 2.564, 95% CI 1.696-3.877, P < 0.001), consumption of rescue analgesia postoperative (OR 1.248, 95% CI 1.047-1.486, P = 0.013), consumption of sedative hypnotic postoperative (OR 2.035, 95% CI 1.159-3.574, P = 0.013), subcutaneous emphysema of chest wall postoperative (OR 1.255, 95% CI 1.000-1.575, P = 0.050), and history of postoperative wound infection (OR 5.949, 95% CI 1.344-1.898, P < 0.001) were independent risk factors for CPSP development.Conclusions: CPSP remains a challenge in clinic because half of patients may develop CPSP after VATS. Trial registration: Chinese Clinical Trial Registry (ChiCTR2100045765), 2021/04/24

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“…age) or injury related factors (e.g. complexity of fracture) are not the most important determinants but that pre-existing pain, psychological factors and socioeconomic factors might have a stronger association [ 15 , 16 ]. We neither found clinical important determinants for failure risks and physical functioning with exception to those that generally decrease mobility (obesity and comorbidity) [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…complexity of fracture) are not the most important determinants but that pre-existing pain, psychological factors and socioeconomic factors might have a stronger association [ 15 , 16 ]. We neither found clinical important determinants for failure risks and physical functioning with exception to those that generally decrease mobility (obesity and comorbidity) [ 15 ]. Thus, it appears that it is not very important to consider the effect of these variables on pain and physical functioning in the decision process on the individually appropriate osteosynthesis.…”

Section: Discussionmentioning

confidence: 99%

Factors predicting failure of internal fixations of fractures of the lower limbs: a prospective cohort study

Prediger

Tjardes

Probst

et al. 2021

BMC Musculoskelet Disord

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View full text Add to dashboard Cite

Background We assessed predictive factors of patients with fractures of the lower extremities caused by trauma. We examined which factors are associated with an increased risk of failure. Furthermore, the predictive factors were set into context with other long-term outcomes, concrete pain and physical functioning. Methods We performed a prospective cohort study at a single level I trauma center. We enrolled patients with traumatic fractures of the lower extremities treated with internal fixation from April 2017 to July 2018. We evaluated the following predictive factors: age, gender, diabetes, smoking status, obesity, open fractures and peripheral arterial diseases. The primary outcome was time to failure (nonunion, implant failure or reposition). Secondary outcomes were pain and physical functioning measured 6 months after initial surgery. For the analysis of the primary outcome, we used a stratified (according fracture location) Cox proportional hazard regression model. Results We included 204 patients. Overall, we observed failure in 33 patients (16.2 %). Most of the failures occurred within the first 3 months. Obesity and open fractures were associated with an increased risk of failure and decreased physical functioning. None of the predictors showed an association with pain. Age, female gender and smoking of more than ≥ 10 package years increased failure risk numerically but statistical uncertainty was high. Conclusions We found that obesity and open fractures were strongly associated with an increased risk of failure. These predictors seem promising candidates to be included in a risk prediction model and can be considered as a good start for clinical decision making across different types of fractures at the lower limbs. However, large heterogeneity regarding the other analyzed predictors suggests that “simple” models might not be adequate for a precise personalized risk estimation and that computer-based models incorporating a variety of detailed information (e.g. pattern of injury, x-ray and clinical data) and their interrelation may be required to significantly increase prediction precision. Trial registration NCT03091114.

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External Validation and Update of the RICP—A Multivariate Model to Predict Chronic Postoperative Pain

Abstract: The study indicates external validity of the original RICP. The updated RICP also showed good predictive ability. The results are limited by the small sample size and the amount of missing outcome data.

Cited by 19 publications

References 29 publications

Factors Predicting Failure of Internal Fixations of Fractures of the Lower Limbs: a Prospective Cohort Study

Factors Predicting Failure of Internal Fixations of Fractures of the Lower Limbs: a Prospective Cohort Study

Incidence and Risk Factors for Chronic Postsurgical Pain Following Video-assisted Thoracoscopic Surgery: a Retrospective Study

Factors predicting failure of internal fixations of fractures of the lower limbs: a prospective cohort study

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