Prognostic factors for chronic post-surgical pain after lung or pleural surgery: a protocol for a systematic review and meta-analysis

Abstract

IntroductionChronic post-surgical pain (CPSP) after lung or pleural surgery is a common complication and associated with a decrease in quality of life, long-term use of pain medication and substantial economic costs. An abundant number of primary prognostic factor studies are published each year, but findings are often inconsistent, methods heterogeneous and the methodological quality questionable. Systematic reviews and meta-analyses are therefore needed to summarise the evidence.Methods and analysisThe reporting of this protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. We will include retrospective and prospective studies with a follow-up of at least 3 months reporting patient-related factors and surgery-related factors for any adult population. Randomised controlled trials will be included if they report on prognostic factors for CPSP after lung or pleural surgery. We will exclude case series, case reports, literature reviews, studies that do not report results for lung or pleural surgery separately and studies that modified the treatment or prognostic factor based on pain during the observation period. MEDLINE, Scopus, Web of Science, Embase, Cochrane, CINAHL, Google Scholar and relevant literature reviews will be searched. Independent pairs of two reviewers will assess studies in two stages based on the PICOTS criteria. We will use the Quality in Prognostic Studies tool for the quality assessment and the CHARMS-PF checklist for the data extraction of the included studies. The analyses will all be conducted separately for each identified prognostic factor. We will analyse adjusted and unadjusted estimated measures separately. When possible, evidence will be summarised with a meta-analysis and otherwise narratively. We will quantify heterogeneity by calculating the Q and I2 statistics. The heterogeneity will be further explored with meta-regression and subgroup analyses based on clinical knowledge. The quality of the evidence obtained will be evaluated according to the Grades of Recommendation Assessment, Development and Evaluation guideline 28.Ethics and disseminationEthical approval will not be necessary, as all data are already in the public domain. Results will be published in a peer-reviewed scientific journal.PROSPERO registration numberCRD42021227888.

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“…The meta-analysis, which is based on direct comparisons of well-planned randomized controlled trials, has been considered as the gold standard for determining the effectiveness of interventions [ 4 ]. In clinical practice, there is no evidence of direct comparative studies on the efficacy of many different interventions.…”

“…erefore, the timely and effective clinical treatment of oral ulcer patients with scientific and reasonable treatment plans has very important clinical significance for enhancing the quality of life. e meta-analysis, which is based on direct comparisons of well-planned randomized controlled trials, has been considered as the gold standard for determining the effectiveness of interventions [4]. In clinical practice, there is no evidence of direct comparative studies on the efficacy of many different interventions.…”

Prognostic factors for chronic post‐surgical pain after lung and pleural surgery: a systematic review with meta‐analysis, meta‐regression and trial sequential analysis

“…Fourth, our analysis is more recent compared with that by Lim et al., since they searched until November 2019, and more complete as compared with Chen et al., since they included only 17 video‐assisted thoracic surgery studies. Finally, we have prespecified our protocol both in a PROSPERO registration and a separate published protocol [30]. Smith and Carlisle emphasised the role of publishing the study protocol for transparency and minimising selective reporting bias in systematic reviews and meta‐analyses [39], a notion that has been supported by others [107].…”

“…The reporting of this systematic review and meta‐analysis follows the Preferred Reporting Items for Systematic reviews and Meta‐Analyses checklist [29]. We used the guide for systematic reviews and meta‐analyses for prognostic factor studies from the prognosis research strategy group in the design [24] and the study methods have also been described in detail in our published protocol [30].…”

“…Given the high number of studies and prognostic factors that were found to be significantly associated with the outcome in our conventional meta‐analyses, we decided to account for the risk of spurious findings. We extended the methodology as described in our study protocol [30], and additionally added trial sequential analysis to exclude the possibility that type 1 and type 2 errors could hamper the confidence into our results. Trial sequential analysis was therefore performed for prognostic factors summarised with a meta‐analysis to account for type 1 and type 2 errors and to determine whether enough evidence had been reached.…”