Kalkman et al developed a model and nomogram for the preoperative prediction of severe postoperative pain. This can help identify a patient who may benefit from closer monitoring and more aggressive management of pain. The authors are from the University Medical Center Utrecht, The Netherlands.
Patient selection: age range 15 to > 90 years
Parameters:
(1) gender
(2) age
(3) preoperative pain: 10 cm VAS from 0 (none) to 10 (extreme)
(4) surgery type
(5) incision size
(6) anxiety level (based on the anxiety subscore of the Amsterdam Preoperative Anxiety and Information Scale, APAIS)
(7) need for information (based on the need for information subscore of the Amsterdam Preoperative Anxiety and Information Scale, APAIS)
|
Parameter |
Findings |
Points |
|---|---|---|
|
gender |
male |
0 |
|
|
female |
3 |
|
age |
15 - 19 |
17 |
|
|
20 - 24 |
16 |
|
|
25 - 29 |
15 |
|
|
30 - 34 |
13 |
|
|
35 - 39 |
12 |
|
|
40 - 44 |
11 |
|
|
45 - 49 |
10 |
|
|
50 - 54 |
9 |
|
|
55 - 59 |
8 |
|
|
60 - 64 |
7 |
|
|
65 - 69 |
6 |
|
|
70 - 74 |
4 |
|
|
75 - 79 |
3 |
|
|
80 - 84 |
2 |
|
|
85 - 89 |
1 |
|
|
>= 90 |
0 |
|
preoperative pain |
0 to 10 |
(value) * 2 |
|
surgery type |
ophthalmology |
0 |
|
|
laparoscopy |
5 |
|
|
ENT |
8 |
|
|
orthopedic |
14 |
|
|
abdominal |
18 |
|
|
other |
7 |
|
incision size |
small (< 10 cm) |
0 |
|
|
medium to large (>= 10 cm) |
3 |
|
anxiety level (APAIS) |
4 to 5 |
0 |
|
|
6 to 7 |
2 |
|
|
8 to 9 |
3 |
|
|
10 to 11 |
5 |
|
|
12 to 13 |
6 |
|
|
14 to 15 |
8 |
|
|
16 to 17 |
9 |
|
|
18 to 19 |
11 |
|
|
20 |
12 |
|
need for info (APAIS) |
2 |
9 |
|
|
3 |
8 |
|
|
4 |
7 |
|
|
5 |
6 |
|
|
6 |
5 |
|
|
7 |
3 |
|
|
8 |
2 |
|
|
9 |
1 |
|
|
10 |
0 |
where:
• The point assignment is based on Appendix A on page 422.
total score =
= SUM(points for all 7 parameters)
Interpretatation:
• minimum score: 0
• maximum score: 82
• The higher the score the greater the risk of severe postoperative pain.
|
Total Score |
Probability of Postoperative Pain |
|---|---|
|
0 |
3% |
|
11 |
5% |
|
22 |
10% |
|
34 |
20% |
|
41 |
30% |
|
48 |
40% |
|
53 |
50% |
|
59 |
60% |
|
65 |
70% |
|
73 |
80% |
If this data is analyzed in Minitab:
|
Total Points |
Percent Probability of Postoperative Pain (from 0 to 100) |
|---|---|
|
0 to 48 |
(0.01776 * ((points)^2)) - (0.08791 * (points)) + 3.279 |
|
48 to 73+ |
(-0.01784 * ((points)^2)) + (3.761 * (points)) - 99.40 |
Purpose: To predict the probability of severe postoperative pain using the model of Kalkman et al.
Specialty: Anesthesiology
Objective: severity, prognosis, stage
ICD-10: R52, Z48,
