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Prognostic Factors for Chronic Post-Surgical Pain After Lung Or Pleural Surgery: a Protocol for a Systematic Review and Meta- Analysis

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Prognostic Factors for Chronic Post-Surgical Pain After Lung Or Pleural Surgery: a Protocol for a Systematic Review and Meta- Analysis Washington University School of Medicine Digital Commons@Becker Open Access Publications 6-15-2021 Prognostic factors for chronic post-surgical pain after lung or pleural surgery: A protocol for a systematic review and meta- analysis Pascal Richard David Clephas Sanne Elisabeth Hoeks Marialena Trivella Christian S Guay Preet Mohinder Singh See next page for additional authors Follow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubs Authors Pascal Richard David Clephas, Sanne Elisabeth Hoeks, Marialena Trivella, Christian S Guay, Preet Mohinder Singh, Markus Klimek, and Michael Heesen Open access Protocol BMJ Open: first published as 10.1136/bmjopen-2021-051554 on 15 June 2021. Downloaded from Prognostic factors for chronic post- surgical pain after lung or pleural surgery: a protocol for a systematic review and meta- analysis Pascal Richard David Clephas ,1 Sanne Elisabeth Hoeks ,1 Marialena Trivella ,2 Christian S Guay ,3 Preet Mohinder Singh ,3 Markus Klimek ,1 Michael Heesen4 To cite: Clephas PRD, ABSTRACT Strengths and limitations of this study Hoeks SE, Trivella M, et al. Introduction Chronic post- surgical pain (CPSP) after Prognostic factors for chronic lung or pleural surgery is a common complication and ► This systematic review and meta- analysis will be post- surgical pain after lung associated with a decrease in quality of life, long- term use or pleural surgery: a protocol the first to systematically identify all prognostic fac- of pain medication and substantial economic costs. An for a systematic review and tors for chronic post- surgical pain after lung or pleu- abundant number of primary prognostic factor studies are meta- analysis. BMJ Open ral surgery and to summarise the evidence. published each year, but findings are often inconsistent, 2021;11:e051554. doi:10.1136/ ► To ensure methodological quality, this systematic re- methods heterogeneous and the methodological quality bmjopen-2021-051554 view and meta-analysis will be conducted following questionable. Systematic reviews and meta- analyses are the PROGnosis RESearch Strategy guide for prog- ► Prepublication history and therefore needed to summarise the evidence. additional supplemental material nostic factor meta- analyses. Methods and analysis The reporting of this protocol for this paper are available ► Heterogeneity in the methods, the study populations adheres to the Preferred Reporting Items for Systematic online. To view these files, and the reported outcomes of the included studies Review and Meta- Analysis Protocols (PRISMA- P) checklist. please visit the journal online together with unexplained heterogeneity, will result We will include retrospective and prospective studies (http:// dx. doi. org/ 10. 1136/ in some level of uncertainty in our conclusions. bmjopen- 2021- 051554). with a follow- up of at least 3 months reporting patient- related factors and surgery- related factors for any adult Received 22 March 2021 population. Randomised controlled trials will be included Accepted 19 May 2021 if they report on prognostic factors for CPSP after lung or INTRODUCTION http://bmjopen.bmj.com/ pleural surgery. We will exclude case series, case reports, Lung or pleural surgery is performed for a literature reviews, studies that do not report results variety of diseases or injuries, such as lung for lung or pleural surgery separately and studies that cancer, cancer of the pleura, lung emphy- modified the treatment or prognostic factor based on pain sema, lung transplantation and abscess after during the observation period. MEDLINE, Scopus, Web of trauma or pleurodesis for recurrent pneu- Science, Embase, Cochrane, CINAHL, Google Scholar and mothorces. The thorax can be surgically relevant literature reviews will be searched. Independent accessed with a regular thoracotomy or with pairs of two reviewers will assess studies in two stages © Author(s) (or their based on the PICOTS criteria. We will use the Quality in less invasive video-assisted thoracic surgery on August 26, 2021 by guest. Protected copyright. employer(s)) 2021. Re- use Prognostic Studies tool for the quality assessment and (VATS). Thoracic surgery is associated with permitted under CC BY- NC. No the CHARMS- PF checklist for the data extraction of the chronic post- surgical pain (CPSP), which is commercial re- use. See rights included studies. The analyses will all be conducted classified as any pain related to the surgery and permissions. Published by BMJ. separately for each identified prognostic factor. We will and persisting for 3 months or longer after analyse adjusted and unadjusted estimated measures 1 2 1Anesthesiology, Erasmus MC, surgery. CPSP often starts as a hard to separately. When possible, evidence will be summarised Rotterdam, Zuid- Holland, The control and acute post- surgical pain which Netherlands with a meta- analysis and otherwise narratively. We later transitions into a persisting chronic 2 2Cardiovascular Medicine, will quantify heterogeneity by calculating the Q and I pain.3 The pain is regularly localised at the Clinical Sciences Division, statistics. The heterogeneity will be further explored with chest wall and related to the area of surgery, Oxford University, Oxford, UK meta- regression and subgroup analyses based on clinical 3 but it can also be referred to a different area. Anesthesiology, Washington knowledge. The quality of the evidence obtained will be University School of Medicine in It commonly increases with movement and evaluated according to the Grades of Recommendation 4 5 St Louis, St Louis, Missouri, USA Assessment, Development and Evaluation guideline 28. often has a neuropathic component. CPSP 4 Anesthesiology, Kantonsspital Ethics and dissemination Ethical approval will not be has been observed in as many as 57% and 47% Baden AG, Baden, Switzerland necessary, as all data are already in the public domain. of the patients 3 and 6 months after thoracic 6 Correspondence to Results will be published in a peer- reviewed scientific surgery, respectively. Hence, thoracic Pascal Richard David Clephas; journal. surgery has the highest incidence of CPSP p. clephas@ erasmusmc. nl PROSPERO registration number CRD42021227888. among all types of surgery.3 7 VATS is assumed Clephas PRD, et al. BMJ Open 2021;11:e051554. doi:10.1136/bmjopen-2021-051554 1 Open access BMJ Open: first published as 10.1136/bmjopen-2021-051554 on 15 June 2021. Downloaded from to be less painful compared with a regular thoracotomy Table 1 Summary table of the PICOTS used as selection because it is less invasive, however, incidence and severity criteria of CPSP have been reported to be similar.8 CPSP after thoracic surgery has been associated with a lower overall Any population of adult participants (18 quality of life,9–13 and chronic pain is associated with an years or older) who have had any type of Population lung or pleural surgery. increased utilisation of healthcare, increased absenteeism and decreased work-related effectiveness.14–16 The direct Index Pre- identified prognostic factors: prognostic Preoperative pain, postoperative pain, health- related costs of chronic pain have been reported 17 factors pain catastrophising score, age, gender, to be US$11 846 annually, and the indirect work- related body mass index, diabetes mellitus, 17 costs have been reported to be US$29 617 annually. exercise tolerance, malignant diseases, The burden of CPSP for cancer survivors is also increas- chemotherapy, radiation therapy, surgery ingly recognised, given the progress that has been made duration, anaesthesia technique and surgical in cancer treatment.18 Furthermore, CPSP often results technique. Any newly identified prognostic in the long- term use of pain medication, particularly factors will also be considered. opioids, which contributes to overuse, misuse and addic- Comparator Because we will systematically identify tion of opioids,19–21 and thoracic surgery as an indepen- prognostic all prognostic factors and summarise the dent factor has also been associated with prolonged factors evidence, no comparator prognostic factors postoperative opioid use.22 Thus, CPSP has significant are involved. health and economic related consequences and is a prob- Outcome Chronic post- surgical pain as outcome. lematic complication. Evidence for prognostic factors can Timing Follow- up of 3 months or more. contribute to improved clinical decision-making and indi- Setting Any healthcare setting. vidualised risk prediction by healthcare providers. A prog- nostic factor is defined as any variable affecting the risk of a particular health outcome and should be evaluated in a METHODS AND ANALYSIS representative sample of patients assembled at the same The reporting of this protocol adheres to the Preferred time point in the course of their disease.23 24 It can also Reporting Items for Systematic Review and Meta-Analysis contribute to the development of treatment strategies Protocols (PRISMA-P) checklist.30 31 It has been registered by identifying modifiable prognostic factors as targets.25 at the International Prospective Register of Systematic This systematic review and meta-analysis will focus on all Reviews. For the project design we used guidance from relevant reported prognostic factors for CPSP after lung the PROGnosis RESearch Strategy group, and specifically or pleural surgery. There are two main categories we are the guide for systematic reviews and meta- analyses for interested in: Patient- related factors and surgery-related 26 prognostic factor studies. The
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