Nomogram prediction of chronic postsurgical pain in patients with lung adenocarcinoma after video-assisted thoracoscopic surgery: A prospective study

Abstract

Chronic postsurgery pain (CPSP) refers to persistent or repeated pain around the incision after surgery. Different from acute postoperative pain, the persistence of CPSP seriously affects the quality of life of patients. CPSP has a considerable global impact due to large surgical volumes. Although the development of video-assisted thoracoscopy (VATS) has reduced the risk of CPSP, it still seriously affects patients’ quality of life. Clinical recognition of CPSP at an early stage is limited; therefore, we aimed to develop and validate a nomogram to identify the significant predictive factors associated with CPSP after VATS in patients with lung adenocarcinoma. We screened 137 patients with invasive adenocarcinoma of the lung from among 312 patients undergoing VATS. In this prospective study, patients were divided into the CPSP (n = 52) and non-CPSP (n = 85) groups according to the occurrence of CPSP. Relevant information was collected 1 day before surgery and 1–3 days after surgery, and the occurrence of CPSP was followed up by telephone at 3 months after surgery. Data on clinical characteristics and peripheral blood leukocyte miRNAs were used to establish a nomogram for predicting CPSP using least absolute shrinkage and selection operator (LASSO) regression methods. The area under curve (AUC) was used to determine the recognition ability of the nomograms. The model was subjected to correction and decision curve analyses. Four variables—body mass index (BMI), history of chronic pain, miR 550a-3p, and visual analog scale (VAS) score on postoperative day 2 (VAS2d)—were selected according to LASSO regression to build the nomogram. The nomogram demonstrated adequate calibration and discrimination in the prediction model, with an AUC of 0.767 (95% confidence interval: 0.679–0.856). The calibration plot showed the best fit between model predictions and practical observations, suggesting that the use of the proposed nomogram to predict CPSP is beneficial. A nomogram consisting of BMI, history of chronic pain, miR 550a-3p, and VAS2d predicted the risk of CPSP after VATS in patients with lung adenocarcinoma.

Risk factors and related miRNA phenotypes of chronic pain after thoracoscopic surgery in lung adenocarcinoma patients

“…The sample size was calculated using the minimal clinically difference found in our previous study (History of Chronic Pain in CPSP group: 0.2885 and non-CPSP group:0.1294) [ 12 ]. And yielded the following results: 95 cases in the CPSP group and 155 cases in the non-CPSP group (α = 0.05; power = 0.9; ratio of sample size: 0.61; two-sided; lost to follow-up ratio: 0.1).…”

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][35][36][37][38]] used only preoperative factors, three models [39-41] used preoperative and intraoperative factors, seven models [42][43][44][45][46][47][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 cutoffs (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].…”

Comparison of ultrasound-guided subtransverse process interligamentary plane block with paravertebral block for postoperative analgesia in thoracic surgery: protocol for a randomised non-inferiority trial

“…Uniportal VATS, a minimally invasive technique using a single incision, offers benefits including diminished postoperative pain, shorter hospital stays and enhanced cosmetic outcomes compared with traditional multiport VATS 2. However, acute postoperative pain remains a prevalent symptom following uniportal VATS 3 4. Inadequate pain management can negatively affect recovery, increase the risk of pulmonary complications and contribute to the development of chronic postsurgical pain 5.…”