Abstract
Background: Patients may face the risk of pain during transition from the surgical intensive care unit (SICU) to the surgical ward. The incidence and risk factors of pain during this period are currently unclear.
Objective: To investigate the prevalence and risk factors of moderate to severe pain in critical postoperative patients during the transition period (24 h before and 24 h after transfer) from the SICU to the surgical ward and to construct a nomogram for predicting the moderate to severe pain in critical postoperative patients during the transition from the SICU to the surgical ward.
Design: A prospective survey study
Methods: 552 patients，data were collected between June 2021 and April 2022 at West China Hospital, Sichuan University by convenience sampling. Descriptive, bivariate, and logistic regression analyses were performed, after which a prediction nomogram was constructed. The Hosmer-Lemeshow goodness-of-fit test and calibration curve were used to evaluate the calibration of the nomogram, and the area under the receiver operating characteristic curve (AUC) was used to evaluate its discriminatory ability.
Results: In total, 552 patients were included in the study, 28.44% of whom experienced moderate to severe pain during the 24-h transition period. The independent risk factors for moderate to severe pain identified by logistic regression analysis were acute pain 24 h before transfer out (odds ratio [OR] = 4.644; P < 0.001), APACHE II score (OR = 6.721; P < 0.001), length of stay in the SICU (OR = 3.344; P = 0.012), and number of drainage tubes (OR = 1.382; P = 0.023). A nomographic prediction model was established based on the weighting of these four risk factors. The AUC of the model was 0.975 (95% confidence interval: 0.964–0.987). The Hosmer-Lemeshow test (P=0.551) and calibration curve showed good calibration for the prediction of the moderate to severe pain in critical postoperative patients during the transition from the SICU to the surgical ward.
Conclusions: A high incidence of pain was observed among critically ill postoperative patients during the 24-h transition period from the SICU to the surgical ward. Acute pain 24 h before transfer out, APACHE II score, length of stay in the SICU, and number of drainage tubes were found to be significantly associated with moderate to severe pain in critical postoperative patients during the transition from the SICU to the surgical ward. The predictive nomogram was useful in identifying the risk factors of moderate to severe pain in critical postoperative patients.