Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection
Abstract Objectives Although robotic-assisted thoracic surgery (RATS) provides improved dexterity, the effect of RATS on pain compared with video-assisted thoracoscopic surgery (VATS) or open lobectomy is poorly understood. This study evaluated acute and chronic pain following RATS, VATS, and open a...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2017-08, Vol.154 (2), p.652-659.e1 |
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| container_title | The Journal of thoracic and cardiovascular surgery |
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| creator | Kwon, Sebastian T., BS Zhao, Lili, PhD Reddy, Rishindra M., MD Chang, Andrew C., MD Orringer, Mark B., MD Brummett, Chad M., MD Lin, Jules, MD |
| description | Abstract Objectives Although robotic-assisted thoracic surgery (RATS) provides improved dexterity, the effect of RATS on pain compared with video-assisted thoracoscopic surgery (VATS) or open lobectomy is poorly understood. This study evaluated acute and chronic pain following RATS, VATS, and open anatomic pulmonary resection. Methods A retrospective review of 498 patients (502 procedures) who underwent RATS (74), VATS (227), and open (201) anatomic pulmonary resection including lobectomy and segmentectomy from 2010 to 2014 was performed to identify factors related to acute and chronic pain. Acute pain scores were analyzed over the first 9 postoperative days. Chronic pain was assessed using the validated PainDETECT survey. Results There were no significant differences in acute or chronic pain between RATS and VATS. There was a significant decrease in acute pain for patients with minimally invasive surgery ( P = .0004). Chronic numbness was significantly higher after open resection (25.5% vs 11.6%; P = .0269) but with no difference in other symptoms of chronic pain. Despite no significant difference in pain scores, 69.2% of patients who received RATS felt the approach affected pain versus 44.2% VATS ( P = .0330). On multivariable analysis, younger age ( P |
| doi_str_mv | 10.1016/j.jtcvs.2017.02.008 |
| format | Article |
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This study evaluated acute and chronic pain following RATS, VATS, and open anatomic pulmonary resection. Methods A retrospective review of 498 patients (502 procedures) who underwent RATS (74), VATS (227), and open (201) anatomic pulmonary resection including lobectomy and segmentectomy from 2010 to 2014 was performed to identify factors related to acute and chronic pain. Acute pain scores were analyzed over the first 9 postoperative days. Chronic pain was assessed using the validated PainDETECT survey. Results There were no significant differences in acute or chronic pain between RATS and VATS. There was a significant decrease in acute pain for patients with minimally invasive surgery ( P = .0004). Chronic numbness was significantly higher after open resection (25.5% vs 11.6%; P = .0269) but with no difference in other symptoms of chronic pain. Despite no significant difference in pain scores, 69.2% of patients who received RATS felt the approach affected pain versus 44.2% VATS ( P = .0330). On multivariable analysis, younger age ( P < .0001), female gender ( P = .0364), and baseline narcotic use ( P = .0142) were associated with acute pain, whereas younger age ( P = .0021) and major complications ( P = .0003) were associated with chronic numbness in patients who received MIS. Conclusions Although minimally invasive approaches resulted in less acute pain and chronic numbness, there were no significant differences between RATS and VATS. In contrast, more RATS patients believed the approach affected their pain, suggesting a difference between reality and perception.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2017.02.008</identifier><identifier>PMID: 28291605</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>acute pain ; Acute Pain - epidemiology ; Acute Pain - etiology ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cardiothoracic Surgery ; chronic pain ; Chronic Pain - epidemiology ; Chronic Pain - etiology ; Female ; Humans ; lobectomy ; Lung - surgery ; Male ; Middle Aged ; Pain, Postoperative - epidemiology ; Pain, Postoperative - etiology ; Pneumonectomy - adverse effects ; Pneumonectomy - methods ; Retrospective Studies ; robotic surgery ; Robotic Surgical Procedures - adverse effects ; Robotic Surgical Procedures - methods ; Thoracic Surgery, Video-Assisted - adverse effects ; Thoracic Surgery, Video-Assisted - methods ; Thoracic Surgical Procedures - adverse effects ; Thoracic Surgical Procedures - methods ; thoracoscopy ; thoracotomy ; Time Factors ; Young Adult</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2017-08, Vol.154 (2), p.652-659.e1</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2017 The American Association for Thoracic Surgery</rights><rights>Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c525t-d2aa228c0f471083585b996901a76edcf1a69e46813566e2b788aa7eae3e572d3</citedby><cites>FETCH-LOGICAL-c525t-d2aa228c0f471083585b996901a76edcf1a69e46813566e2b788aa7eae3e572d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522317302167$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28291605$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kwon, Sebastian T., BS</creatorcontrib><creatorcontrib>Zhao, Lili, PhD</creatorcontrib><creatorcontrib>Reddy, Rishindra M., MD</creatorcontrib><creatorcontrib>Chang, Andrew C., MD</creatorcontrib><creatorcontrib>Orringer, Mark B., MD</creatorcontrib><creatorcontrib>Brummett, Chad M., MD</creatorcontrib><creatorcontrib>Lin, Jules, MD</creatorcontrib><title>Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Abstract Objectives Although robotic-assisted thoracic surgery (RATS) provides improved dexterity, the effect of RATS on pain compared with video-assisted thoracoscopic surgery (VATS) or open lobectomy is poorly understood. This study evaluated acute and chronic pain following RATS, VATS, and open anatomic pulmonary resection. Methods A retrospective review of 498 patients (502 procedures) who underwent RATS (74), VATS (227), and open (201) anatomic pulmonary resection including lobectomy and segmentectomy from 2010 to 2014 was performed to identify factors related to acute and chronic pain. Acute pain scores were analyzed over the first 9 postoperative days. Chronic pain was assessed using the validated PainDETECT survey. Results There were no significant differences in acute or chronic pain between RATS and VATS. There was a significant decrease in acute pain for patients with minimally invasive surgery ( P = .0004). Chronic numbness was significantly higher after open resection (25.5% vs 11.6%; P = .0269) but with no difference in other symptoms of chronic pain. Despite no significant difference in pain scores, 69.2% of patients who received RATS felt the approach affected pain versus 44.2% VATS ( P = .0330). On multivariable analysis, younger age ( P < .0001), female gender ( P = .0364), and baseline narcotic use ( P = .0142) were associated with acute pain, whereas younger age ( P = .0021) and major complications ( P = .0003) were associated with chronic numbness in patients who received MIS. Conclusions Although minimally invasive approaches resulted in less acute pain and chronic numbness, there were no significant differences between RATS and VATS. In contrast, more RATS patients believed the approach affected their pain, suggesting a difference between reality and perception.</description><subject>acute pain</subject><subject>Acute Pain - epidemiology</subject><subject>Acute Pain - etiology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiothoracic Surgery</subject><subject>chronic pain</subject><subject>Chronic Pain - epidemiology</subject><subject>Chronic Pain - etiology</subject><subject>Female</subject><subject>Humans</subject><subject>lobectomy</subject><subject>Lung - surgery</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pain, Postoperative - epidemiology</subject><subject>Pain, Postoperative - etiology</subject><subject>Pneumonectomy - adverse effects</subject><subject>Pneumonectomy - methods</subject><subject>Retrospective Studies</subject><subject>robotic surgery</subject><subject>Robotic Surgical Procedures - adverse effects</subject><subject>Robotic Surgical Procedures - methods</subject><subject>Thoracic Surgery, Video-Assisted - adverse effects</subject><subject>Thoracic Surgery, Video-Assisted - methods</subject><subject>Thoracic Surgical Procedures - adverse effects</subject><subject>Thoracic Surgical Procedures - methods</subject><subject>thoracoscopy</subject><subject>thoracotomy</subject><subject>Time Factors</subject><subject>Young Adult</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUk1v1DAQtRCIbgu_AAn5yKEJY3tjOweQqqoFpEocAImb5XUm1CGJF9tZaX8BfxuHLRy4cJqD38f4vSHkBYOaAZOvh3rI7pBqDkzVwGsA_YhsGLSqkrr5-phsADivGs7FGTlPaQAABax9Ss645i2T0GzIz5uDHRebfZhp6Kl1S0Zq5466-xhm7-je-vKyZBcmTNT2GSONYReyd5f04DsMlU3Jp4wdzfchWheSC_vCTEv8hvF4SUOkYY9zkbU5TKvmMk5htvFIIyZ0q_kz8qS3Y8LnD_OCfLm9-Xz9vrr7-O7D9dVd5Rre5Krj1nKuHfRbxUCLRje7tpUtMKskdq5nVra4lZqJRkrkO6W1tQotCmwU78QFeXXS3cfwY8GUzeSTw3G0M4YlGaaV0s12K0SBihPUxZBSxN7so5_K1oaBWRswg_ndgFkbMMBNaaCwXj4YLLsJu7-cP5EXwJsTAMs3Dx6jSc7j7LDzsWRhuuD_Y_D2H74bfWnKjt_xiGkIS5xLgoaZVAjm03oE6w0wJYAzqcQv6YawIg</recordid><startdate>20170801</startdate><enddate>20170801</enddate><creator>Kwon, Sebastian T., BS</creator><creator>Zhao, Lili, PhD</creator><creator>Reddy, Rishindra M., MD</creator><creator>Chang, Andrew C., MD</creator><creator>Orringer, Mark B., MD</creator><creator>Brummett, Chad M., MD</creator><creator>Lin, Jules, MD</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170801</creationdate><title>Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection</title><author>Kwon, Sebastian T., BS ; Zhao, Lili, PhD ; Reddy, Rishindra M., MD ; Chang, Andrew C., MD ; Orringer, Mark B., MD ; Brummett, Chad M., MD ; Lin, Jules, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c525t-d2aa228c0f471083585b996901a76edcf1a69e46813566e2b788aa7eae3e572d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>acute pain</topic><topic>Acute Pain - epidemiology</topic><topic>Acute Pain - etiology</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiothoracic Surgery</topic><topic>chronic pain</topic><topic>Chronic Pain - epidemiology</topic><topic>Chronic Pain - etiology</topic><topic>Female</topic><topic>Humans</topic><topic>lobectomy</topic><topic>Lung - surgery</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pain, Postoperative - epidemiology</topic><topic>Pain, Postoperative - etiology</topic><topic>Pneumonectomy - adverse effects</topic><topic>Pneumonectomy - methods</topic><topic>Retrospective Studies</topic><topic>robotic surgery</topic><topic>Robotic Surgical Procedures - adverse effects</topic><topic>Robotic Surgical Procedures - methods</topic><topic>Thoracic Surgery, Video-Assisted - adverse effects</topic><topic>Thoracic Surgery, Video-Assisted - methods</topic><topic>Thoracic Surgical Procedures - adverse effects</topic><topic>Thoracic Surgical Procedures - methods</topic><topic>thoracoscopy</topic><topic>thoracotomy</topic><topic>Time Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kwon, Sebastian T., BS</creatorcontrib><creatorcontrib>Zhao, Lili, PhD</creatorcontrib><creatorcontrib>Reddy, Rishindra M., MD</creatorcontrib><creatorcontrib>Chang, Andrew C., MD</creatorcontrib><creatorcontrib>Orringer, Mark B., MD</creatorcontrib><creatorcontrib>Brummett, Chad M., MD</creatorcontrib><creatorcontrib>Lin, Jules, MD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kwon, Sebastian T., BS</au><au>Zhao, Lili, PhD</au><au>Reddy, Rishindra M., MD</au><au>Chang, Andrew C., MD</au><au>Orringer, Mark B., MD</au><au>Brummett, Chad M., MD</au><au>Lin, Jules, MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2017-08-01</date><risdate>2017</risdate><volume>154</volume><issue>2</issue><spage>652</spage><epage>659.e1</epage><pages>652-659.e1</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Abstract Objectives Although robotic-assisted thoracic surgery (RATS) provides improved dexterity, the effect of RATS on pain compared with video-assisted thoracoscopic surgery (VATS) or open lobectomy is poorly understood. This study evaluated acute and chronic pain following RATS, VATS, and open anatomic pulmonary resection. Methods A retrospective review of 498 patients (502 procedures) who underwent RATS (74), VATS (227), and open (201) anatomic pulmonary resection including lobectomy and segmentectomy from 2010 to 2014 was performed to identify factors related to acute and chronic pain. Acute pain scores were analyzed over the first 9 postoperative days. Chronic pain was assessed using the validated PainDETECT survey. Results There were no significant differences in acute or chronic pain between RATS and VATS. There was a significant decrease in acute pain for patients with minimally invasive surgery ( P = .0004). Chronic numbness was significantly higher after open resection (25.5% vs 11.6%; P = .0269) but with no difference in other symptoms of chronic pain. Despite no significant difference in pain scores, 69.2% of patients who received RATS felt the approach affected pain versus 44.2% VATS ( P = .0330). On multivariable analysis, younger age ( P < .0001), female gender ( P = .0364), and baseline narcotic use ( P = .0142) were associated with acute pain, whereas younger age ( P = .0021) and major complications ( P = .0003) were associated with chronic numbness in patients who received MIS. Conclusions Although minimally invasive approaches resulted in less acute pain and chronic numbness, there were no significant differences between RATS and VATS. In contrast, more RATS patients believed the approach affected their pain, suggesting a difference between reality and perception.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28291605</pmid><doi>10.1016/j.jtcvs.2017.02.008</doi><oa>free_for_read</oa></addata></record> |
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| subjects | acute pain Acute Pain - epidemiology Acute Pain - etiology Adolescent Adult Aged Aged, 80 and over Cardiothoracic Surgery chronic pain Chronic Pain - epidemiology Chronic Pain - etiology Female Humans lobectomy Lung - surgery Male Middle Aged Pain, Postoperative - epidemiology Pain, Postoperative - etiology Pneumonectomy - adverse effects Pneumonectomy - methods Retrospective Studies robotic surgery Robotic Surgical Procedures - adverse effects Robotic Surgical Procedures - methods Thoracic Surgery, Video-Assisted - adverse effects Thoracic Surgery, Video-Assisted - methods Thoracic Surgical Procedures - adverse effects Thoracic Surgical Procedures - methods thoracoscopy thoracotomy Time Factors Young Adult |
| title | Evaluation of acute and chronic pain outcomes after robotic, video-assisted thoracoscopic surgery, or open anatomic pulmonary resection |
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