Analysis of influencing factors and establishment of prediction model of acute pain in patients undergoing day surgery in the context of multimodal pain management

SHI Liwen; MU Xiaoxiao; LU Zhihong

doi:10.13276/j.issn.2097-1656.2025.08.013

Abstract：Objective To analyze the risk factors of acute pain 24 h after day surgery,and to establish a risk prediction model.Methods According to the inclusion and exclusion criteria,the clinical data of 1 029 patients who received day surgery strategy in the Department of Anesthesiology of Xijing Hospital,Air Force Medical University from April 2021 to May 2022 were retrospectively selected as the study subjects.A total of 731 patients were selected as the training set,and another 298 patients were selected as the validation set.Univariate analysis was performed on the training set,binary logistic regression analysis was performed on meaningful factors,and independent risk factors were screened out for the construction of nomogram prediction model.The fitting degree of the model was evaluated by Hosmer-Lemeshow goodness of fit test,the consistency was judged by C-index,and the degree of discrimination was evaluated by receiver operating characteristic(ROC)curve.Results Among the 731 patients,154 had moderate to severe pain 24 h after surgery,with an incidence of 21.07％.Univariate results showed that there were statistically significant differences in age,body mass index(BMI),marital status,occupation,etomidate,surgical category,anesthesia duration,types of analgesic drugs,surgical grade,and local infiltration anesthesia between the mild pain group and the moderate to severe pain group(P＜0.05).Multivariate logistic regression analysis indicated that age＜50 years old,BMI＜24 kg/m2,no use of etomidate,elective surgery,surgical grade 4,and no local infiltration anesthesia were independent risk factors for moderate to severe pain(P＜0.05).The Hosmer-Lemeshow goodness of fit test of the established nomogram prediction model indicated that the model had a good fitting degree(x2=7.075,P=0.529).The area under the ROC curve was 0.852(95％CI=0.820-0.883),the sensitivity was 78.6％,and the specificity was 77.5％.The C-index of this prediction model was 0.874,and the internal validation C-index was 0.852.Conclusion Overall,the incidence of moderate to severe pain in patients undergoing day surgery is 21.07％.Age＜50 years old,BMI＜24 kg/m2,no use of etomidate,elective surgery,surgical grade 4,and no local infiltration anesthesia are independent risk factors for moderate to severe pain in patients undergoing day surgery,and the established nomogram prediction model has good predictive ability.