University of Calgary model accurately predicted probability of pain after spine surgery
The Calgary Postoperative Pain After Spine Surgery score may accurately predict the probability of patients experiencing poorly controlled pain, dissatisfaction and poor outcomes after spine surgery, according to published results.
Researchers at the University of Calgary performed a retrospective cohort study on 1,300 adult patients who were consecutively enrolled in the Canadian Spine Outcomes and Research Network registry from Aug. 28, 2014, to Oct. 4, 2017. All patients underwent elective cervical or thoracolumbar spine surgery and were admitted to a hospital for at least 24 hours. Poor postoperative pain control was defined by a mean numeric rating scale score of greater than 4 during the first 24 hours of admission, according to the study.
Using a random 70% sample of the data, researchers developed a prediction model from seven variables associated with poor pain control. They used the remaining 30% of the data to simplify the model into the three-tier Calgary Postoperative Pain After Spine Surgery (CAPPS) score.
According to the study, 57% of patients experienced poorly controlled pain during their first 24 hours of admission. The CAPPS score predicted probability of experiencing poorly controlled pain at 32% for the low-risk group, at 63% for the high-risk group and at 85% for the extreme-risk group. These results were substantiated by a 37%, 62% and 81% respective incidence in the validation cohort, “suggesting good predictive ability of the [CAPPS] score,” the researchers wrote in the study.
Researchers found younger patient age, female sex, preoperative daily opioid use, intense preoperative neck or back pain, depression, surgery involving at least three motion segments and fusion surgery were the seven variables most associated with poor pain control. They also noted that minimally invasive surgery, revision surgery and BMI were not associated with poor pain control, according to the study.
“As clinical practice moves toward personalized medicine, there is an increasing need for reliable predictive tools to help physicians make appropriate therapeutic decisions,” they wrote. “In this study, preoperative factors that predict poorly controlled pain after elective spine surgery were identified and integrated into the internally validated CAPPS score ... This score can be used to facilitate preoperative patient education and the development of personalized clinical care pathways to improve postoperative acute pain outcomes,” the researchers wrote.
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