Influcing factors and prediction model of acute postoperative pain after total hip and total knee ar-throplasty
Objective To investigate the influcing factors of acute postoperative pain(APP)in patients undergoing total hip and total knee arthroplasty,and to establish and verify the prediction model.Methods The clinical data of 316 patients,111 males and 205 females,aged ≥ 18 years,ASA physical status Ⅰ to Ⅲ,who underwent hip and knee arthroplasty were collected.The patients were divided into two groups according to the presence of APP:no APP group and APP group.The patients were randomly divided into a training set and a validation set at a ratio of 7∶3.LASSO regression and multivariate Logistic analysis based on training set were used to screen risk factors to construct a clinical prediction model.The receiver operating characteristic(ROC)curve was drawn and the area under the curve(AUC)was calculat-ed to evaluate the prediction efficiency of the model.In the validation set,the Bootstrap method was used for internal validation,and the clinical decision curve analysis(DC A)was used to evaluate the clinical value of the predictive model.Results APP occurred in 137 patients(43.4％).Multivariate Logistic analysis showed that high BMI,history of diabetes,long operation time,and high pain catastrophizing score ≥ 27 points were independent risk factors for APP in patients undergoing total hip and total knee arthroplasty(P＜0.05),and drainage tube placement,preoperative drug preventive analgesia,postoperative use of an-algesic pump and postoperative nerve block analgesia were the protective factors for APP(P＜0.05).Using BMI,diabetes history,drainage tube placement,operation duration,and pain catastrophization score to es-tablish prediction model.The AUC of the training set and validation set were 0.879(95％CI 0.836-0.922)and 0.819(95％CI 0.730-0.907),respectively.The Bootstrap internal validation showed that the calibration curve had a good agreement between the predicted and measured values,and the DCA curve showed that the prediction model had high clinical application value.Conclusion The risk factors of APP in patients undergoing hip and knee arthroplasty are high BMI,history of diabetes,long operation time,and pain catastrophization score≥27 points,and the protective factors are drainage tube placement,preopera-tive drug preventive analgesia,postoperative use of analgesic pump,and postoperative nerve block.The pre-diction model based on the above factors has good discrimination ability and clinical application.It can provide a scientific reference for predicting the occurrence of APP in patients undergoing hip and knee arthroplasty.
ArthroplastyAcute postoperative painInflucing factorPrediction model
万方数据
维普
