| Objective(s):The effect of pain on the tissue healing outcome and possible mechanism have been researched in animal experiments,but there are few relevant clinical studies.Aim of the study was to explore the influence of different level of postoperative pain on incision healing in lumber surgery patients,to improve clinical postoperative pain management,minimize the adverse effect of pain on incision healing.Methods:This is a single-center,prospective cohort study,after approved by the Ethics Committee,the patients from January 2022 to September 2022 was sequentially included.According to the VAS score at 24 hours postoperatively,the patients were divided into four groups,group 0,group 1-3,group 4-6,group 7-10,matched with the patients who felt painless,slight pain,mild pain and severe pain postoperatively.During 28 days after surgery,we evaluated the incision healing outcomes according to the patient’s electronic disease records or the telephone follow-up after discharge,referred to the criteria of the Centers for Disease Control and Prevention,recorded as well-healed or poorly-healed,and the appearance time for poorly-healed outcome,the blood routine and blood biochemical indicators of patients before operation,on the day after operation,on day 3 and 7 after operation also were recorded.The SPSS software was used to analyzed the data and explore the influence of different level of acute pain to postoperative lumber wound healing.Results:A total of 335 patients were included and analyzed,20(6%)in group 0,215(64.2%)in group 1-3,81(24.2%)in group 4-6,and 19(5.6%)in group 7-10.After x~2test,survival analysis and multivariate regression analysis,the four groups of patients have no significant difference in the healing outcome(x~2=1.843,P=0.615,HR=1.859,95%CI=0.732-4.721,P=0.192).There was also no significant difference in the 24h VAS score between the well-healed group and poorly-healed group after Mann-Whitney test(Z=-1.317,P=0.188).The survival curve was plotted based on the time at which the poorly-healed outcome occurred,the slope of the survival curve in groups 0 and 7-10 was steeper than that in the other groups,and the speed of the occurrence of poorly healed was faster.However,after the Log-Rank test,it was found that there was no significant difference in the survival curve between the four groups(P=0.572),and the BMI(HR=1.043,95%CI 1.006-1.082,P=0.024),intraoperative bleeding volume(HR=1.002,95%CI 1-1.004,P=0.044)had statistic difference on incision healing after multivariate Cox regression analysis(P<0.05).The blood routine and blood biochemical indicators were compared between different healing outcome groups,there was no statistical difference in the two groups for parallel comparison(P>0.05),and no statistically significant difference in variation value which compared with preoperative value(P>0.05).After making a trend chart of the changes of various indicators in the perioperative period and general linear analysis found that compared with the poorly-healed group,the well-healed group had a lower ESR level within 5 days after surgery,but had a higher ESR level on the 7th day after surgery,and the trend of ESR change was different between groups(P=0.049),but no statistical difference in other indicators between the two groups(P>0.05).Conclusion(s):Pain management is essential for postoperative recovery,but we haven’t found that the degree of pain 24 hours after surgery is relevant with wound healing of patients undergoing lumbar surgery.Increased BMI and intraoperative bleeding are risk factors for tissue healing.ESR may be a predictive indicator of tissue healing outcomes,but further research is needed to clarify.There are some interferences,so we require high-quality,large sample studies to continue to explore the relationship between postoperative pain levels and incision healing outcomes,in order to optimize perioperative analgesia strategies. |
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