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. 2022 Jul 26:9:911864.
doi: 10.3389/fsurg.2022.911864. eCollection 2022.

The duration of postoperative analgesic use after total knee arthroplasty and nomogram for predicting prolonged analgesic use

Yi Zhang  1   2 , Zihua Li  1 , Qihang Su  1 , Heng'an Ge  1 , Biao Cheng  1 , Meimei Tian  1
Affiliations

The duration of postoperative analgesic use after total knee arthroplasty and nomogram for predicting prolonged analgesic use

Yi Zhang et al. Front Surg. .

Abstract

Background: Total knee arthroplasty is currently a reliable treatment for end-stage knee osteoarthritis. However, chronic postsurgical pain (CPSP) is substantially thought to reduce patient satisfaction. NSAID-based oral analgesics were used to manage CPSP, but research on the duration of postoperative analgesic use (DAU) and prolonged analgesic use (PAU) are presently scarce.

Methods: Preoperative, perioperative, and one-year or above postoperative follow-up data were collected from 162 patients who underwent total knee arthroplasty between 1 June 2018 and 1 March 2019, and the DAU and the discontinuation time of each patient after discharge were recorded. Observational statistical analysis, diagnostic test, and predictive nomogram construction were performed on the collected data.

Results: The 3-month DAU has good diagnostic utility for poor outcome of postoperative months twelve (POM12). The constructed nomogram shows that gender, preoperative Numeric Rating Scale (NRS) movement pain scores, duration of surgery, postoperative days three (POD3) moderate to severe movement pain, and POD3 pain rescue medication were significant prognostic predictors of PAU after discharge. The area under the curve (AUC) of the 3-month, 6-month, and 12-month nomogram receiver operating characteristic (ROC) curves were calculated to be 0.741, 0.736, and 0.781.

Conclusion: PAU was defined as more than three months of NSAID-based oral analgesic use after TKA. Prognostic predictors of PAU after TKA were identified, and visualized nomogram was plotted and evaluated. The evaluation indicated that the prediction model had the good predictive ability and was a valuable tool for predicting PAU after discharge.

Keywords: Arthroplasty; NSAID; analgesic use; nomogram; postsurgical pain.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The flow chart of research process.
Figure 2
Figure 2
Descriptive statistical analysis of DAU. (A) Frequency distribution of DAU, POM12 satisfaction score, and POM12 Lysholm score. (B) Venn diagram of four subgroups of POM12 poor outcome. (C) DAU of cases with or without adverse outcomes. ***, p < 0.001; ****, p < 0.0001.
Figure 3
Figure 3
(A–E) ROC curve of DAU for different POM12 poor outcomes. (F) Venn diagram of PAU and POM12 poor outcome. (G) POM12 satisfaction score and POM12 Lysholm score of cases with or without PAU. (H) Frequency distribution histogram of POM moderate to severe pain.
Figure 4
Figure 4
K-M survival curves for categorical data. (A) Gender; (B) duration of surgery; (C) POD3 moderate to severe movement pain (D) POD3 pain rescue medication.
Figure 5
Figure 5
Nomogram for predicting PAU.
Figure 6
Figure 6
Receiver operating characteristic (ROC) curve for the prediction model. The 3-month, 6-month, and 12-month areas under the curve (AUC) were 0.741, 0.736, and 0.781.
Figure 7
Figure 7
Calibration curves of the nomogram. The x-axis shows the predicted probability of PAU, and the y-axis shows the observed probability of PAU.
See this image and copyright information in PMC

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