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Zhang Y, Zhou R, Hou B, Tang S, Hao J, Gu X, Ma Z, Zhang J. Incidence and risk factors for chronic postsurgical pain following video-assisted thoracoscopic surgery: a retrospective study. BMC Surg 2022; 22:76. [PMID: 35236334 PMCID: PMC8892711 DOI: 10.1186/s12893-022-01522-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/18/2022] [Indexed: 12/20/2022] Open
Abstract
Background 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 2348 patients were included in our study. The incidence of CPSP after VATS were 43.99% (n = 1033 of 2348). Within those suffering CPSP, 14.71% (n = 152 of 1033) 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. 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), and history of postoperative wound infection (OR 5.949, 95% CI 3.153–11.223, 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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Affiliation(s)
- Yingying Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Rong Zhou
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Bailing Hou
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Suhong Tang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Jing Hao
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Xiaoping Gu
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China
| | - Zhengliang Ma
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
| | - Juan Zhang
- Department of Anesthesiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, China.
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Predictors of low quality of life after open inguinal hernia repair using the EuraHS-QoL score: prospective multicentric cohort study across 33 hospitals. Hernia 2021; 26:225-232. [PMID: 34727286 DOI: 10.1007/s10029-021-02498-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/23/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Evidence about factors influencing quality of life after inguinal hernia surgery is scarce. This study aimed to assess patient's Quality of Life (QoL) after open inguinal hernia repair and to identify predictors of low QoL at 3 months after surgery, to guide practice and inform patients at high risk. METHODS Prospective multicentric cohort study including consecutive patients undergoing elective open inguinal hernia repair in Portuguese hospitals (October-December 2019). The primary outcome was Quality of Life at 3 months after surgery, using the EuraHS-QoL score (higher score correlates with lower QoL). Low QoL was defined as the higher EuraHS-QoL score tertile and multivariate logistic regression was used to identify predictors. RESULTS 893 patients were included from 33 hospitals. The majority were men [89.9% (800/891)], had unilateral hernias 88.7% (774/872) and the most common surgical technique was Lichtenstein's repair [52.9% (472/893)]. The median QoL score was 24 (IQR 10-40) before surgery and 2 (IQR 0-10) at 3 months after surgery, showing significant improvement (p < 0.001). After adjustment, low QoL at 3 months was associated with low preoperative QoL (OR 1.76, 95% CI 1.21-2.57, p = 0.003), non-absorbable mesh fixation (OR 1.64, 95% CI 1.12-2.41, p = 0.011), severe immediate postoperative pain (OR 2.90, 95% CI 1.66-5.11, p < 0.001) and minor postoperative complications (OR 2.23, 95% CI 1.30-3.84, p = 0.004). CONCLUSION This study supports the use of the EuraHS-QoL score preoperatively to inform consent. Although significant improvement in QoL is expected after surgery, high scores before surgery are associated with low postoperative QoL. Caution should be taken with non-absorbable mesh fixation and immediate postoperative pain control should be optimised.
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Winkler P, Formanek T, Mlada K, Kagstrom A, Mohrova Z, Mohr P, Csemy L. Increase in prevalence of current mental disorders in the context of COVID-19: analysis of repeated nationwide cross-sectional surveys. Epidemiol Psychiatr Sci 2020; 29:e173. [PMID: 32988427 PMCID: PMC7573458 DOI: 10.1017/s2045796020000888] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/09/2020] [Accepted: 09/24/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS The United Nations warned of COVID-19-related mental health crisis; however, it is unknown whether there is an increase in the prevalence of mental disorders as existing studies lack a reliable baseline analysis or they did not use a diagnostic measure. We aimed to analyse trends in the prevalence of mental disorders prior to and during the COVID-19 pandemic. METHODS We analysed data from repeated cross-sectional surveys on a representative sample of non-institutionalised Czech adults (18+ years) from both November 2017 (n = 3306; 54% females) and May 2020 (n = 3021; 52% females). We used Mini International Neuropsychiatric Interview (MINI) as the main screening instrument. We calculated descriptive statistics and compared the prevalence of current mood and anxiety disorders, suicide risk and alcohol-related disorders at baseline and right after the first peak of COVID-19 when related lockdown was still in place in CZ. In addition, using logistic regression, we assessed the association between COVID-19-related worries and the presence of mental disorders. RESULTS The prevalence of those experiencing symptoms of at least one current mental disorder rose from a baseline of 20.02 (95% CI = 18.64; 21.39) in 2017 to 29.63 (95% CI = 27.9; 31.37) in 2020 during the COVID-19 pandemic. The prevalence of both major depressive disorder (3.96, 95% CI = 3.28; 4.62 v. 11.77, 95% CI = 10.56; 12.99); and suicide risk (3.88, 95% CI = 3.21; 4.52 v. 11.88, 95% CI = 10.64; 13.07) tripled and current anxiety disorders almost doubled (7.79, 95% CI = 6.87; 8.7 v. 12.84, 95% CI = 11.6; 14.05). The prevalence of alcohol use disorders in 2020 was approximately the same as in 2017 (10.84, 95% CI = 9.78; 11.89 v. 9.88, 95% CI = 8.74; 10.98); however, there was a significant increase in weekly binge drinking behaviours (4.07% v. 6.39%). Strong worries about both, health or economic consequences of COVID-19, were associated with an increased odds of having a mental disorder (1.63, 95% CI = 1.4; 1.89 and 1.42, 95% CI = 1.23; 1.63 respectively). CONCLUSIONS This study provides evidence matching concerns that COVID-19-related mental health problems pose a major threat to populations, particularly considering the barriers in service provision posed during lockdown. This finding emphasises an urgent need to scale up mental health promotion and prevention globally.
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Affiliation(s)
- P. Winkler
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, London SE5 8AF, UK
| | - T. Formanek
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - K. Mlada
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
- Faculty of Medicine in Pilsen, Charles University, Husova 3, 301 00Pilsen, Czech Republic
| | - A. Kagstrom
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - Z. Mohrova
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
| | - P. Mohr
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
- Third Faculty of Medicine, Charles University, Ruska 87, 100 00Prague, Czech Republic
| | - L. Csemy
- National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czech Republic
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The Predictive Role of Executive Functions and Psychological Factors on Chronic Pain after Orthopaedic Surgery: A Longitudinal Cohort Study. Brain Sci 2020; 10:brainsci10100685. [PMID: 32998214 PMCID: PMC7601771 DOI: 10.3390/brainsci10100685] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/16/2020] [Accepted: 09/23/2020] [Indexed: 12/20/2022] Open
Abstract
Prevention and treatment of chronic post-surgical pain should be based on the early identification of patients at risk. The presence of a deficit in executive functions, along with the presence of psychological risk factors, could impair the use of appropriate pain coping strategies and might facilitate the transition to chronic post-surgical pain. A longitudinal cohort study was implemented. Patients listed for orthopaedic surgery were enrolled. Variables measured before surgery were pain intensity, the sensory, affective, cognitive and mixed components of pain, state and trait variables associated with the psychological status of the patient, fear of movement, pain catastrophizing, visual attention and cognitive flexibility. Pain intensity and the components of pain were re-evaluated after surgery and after three months. A linear mixed model was used to assess the predictors of pain intensity, and a multivariate linear mixed model was used to assess the predictors of the pain components. 167 patients were enrolled. Controlling for sex, age, pain duration and surgical procedure, catastrophizing and visual attention were predictors of pain intensity at follow-up. The sensory component of pain was predicted by state anxiety, healthcare-related fears, pain catastrophizing and visual attention. Anxiety and catastrophizing were predictors of the affective and evaluative components of pain. The mixed component of pain was predicted by state anxiety, healthcare-related fears and pain catastrophizing. Executive functions, along with psychological risk factors, shape the course of post-surgical pain. The efficacy of preventive and rehabilitation treatment could be possibly enhanced if these factors are treated.
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