Construction and validation of a predictive model for chronic pain after single-port video-assisted thoracic surgery
Objective:To explore the risk factors for chronic pain after single-port video-assisted thoracic surgery(VATS)and establish the predictive model to validate it.Methods:A retrospective analysis was conducted on 302 patients who underwent single-port VATS at department of thoracic surgery,the Affiliated Brain Hospital of Nanjing Medical University from January to June 2023.Clinical data of patients were collected.A numerical rating scale(NRS)was used to assess the degree of pain in patients three months after surgery,and the patients were divided into the pain group and the non-pain group.The patients were also randomly divided into a training set(n=214)and a validation set(n=88)at a 7∶3 ratio,and univariate analysis was performed on the training set.Multivariate logistic regression analysis was used to establish a predictive model.Reciever operating characteristic(ROC)curve was used to evaluate model discrimination,calibration curve was used to evaluate model consistency,decision curve analysis(DCA)was used to evaluate the clinical value of the model,and the model was verified in the validation set.Results:The multivariate analysis showed that age(OR=0.925,95％CI:0.872-0.981,P=0.009),postoperative closed chest drainage time(OR=1.273,95％CI:1.018-1.591,P=0.034),C-reactive protein(CRP)value on the first day after surgery(OR=1.090,95％CI:1.030-1.153,P=0.003),and NRS score on the first day after surgery(OR=3.060,95％CI:1.879-4.981,P＜0.001)were independent risk factors for chronic pain after single-port thoracoscopy.Based on this,a prediction model was constructed,with an area under the ROC curve of 0.871(95％CI:0.799-0.943)and the cut-off value corresponding to the maximum Yoden index was to 0.195 with a sensitivity of 76.5％and a specificity of 85.6％.With a Bootstrap sample of 1 000 times,the predicted risk of chronic pain by the calibration curve was highly consistent with the actual risk.The DCA curve indicated positive returns at all predicted probabilities.Conclusion:After single-port VATS,patient age,time of closed thoracic drainage after surgery,CRP value on the first day after surgery,and NRS score on the first day after surgery are all independent risk factors for chronic postsurgical pain.This prediction model may be helpful in accurately predicting chronic postoperative pain and may has good clinical application value.
万方数据
维普
