Related Experiment Video
Updated: Aug 5, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Development and Validation of a Nomogram for Predicting Acute Postoperative Pain After Orthognathic Surgery
Li-Kuan Wang1, Hai-Yin Wu1, Xu-Dong Yang2
1Associate Chief Physician, Department of Anesthesiology, Peking University Hospital of Stomatology, Beijing, China.
Background:
Identifying patients at high risk of postoperative pain may improve pain management strategies.
Purpose:
The purpose was to develop and validate a predictive model for acute postoperative pain (APP) following orthognathic surgery.
Study Design, Setting, Sample:
This retrospective cohort study was conducted at Peking University Hospital of Stomatology and included individuals aged ≥18 years who underwent orthognathic surgery. Patients with incomplete 5-day postoperative follow up and no numerical rating scale of pain >3 on any completed day were exclude.
Predictor Variables:
The predictor variable was a set of variables categorized as demographic, psychological, surgical, and perioperative variables.
Main Outcome Variable:
The main outcome variable was APP severity, assessed using a 1 to 10 numerical rating scale. Moderate-to-severe APP was defined as a score >3 at any time within the first 5 postoperative days.
Covariates:
None.
Analyses:
The dataset was split into training and validation sets at a 7:3 ratio by simple random sampling. Predictor selection used the least absolute shrinkage and selection operator, followed by multivariate logistic regression. Model performance was assessed by the area under the curve, calibration curves, and decision curve analysis. Diagnostic performance parameters were calculated. A P value < .05 was considered statistically significant.
Results:
The sample was composed of 566 subjects with a median age of 25 (21 to 29), and 415 (73.3%) were female. There were 399 (70.5%) and 167 (29.5%) subjects in the training and validation model, respectively. Independent factors for moderate-to-severe APP included preoperative State-Trait Anxiety Inventory-Trait score, preoperative pain catastrophizing scale score, intraoperative remifentanil dose, and intraoperative or postanesthesia care unit dexmedetomidine use. The area under the curve was 0.848 (95% CI, 0.809 to 0.886) for training and 0.829 (95% CI, 0.766 to 0.892) for validation. In the training set, sensitivity was 74.7%, specificity 82.8%, positive predictive value 75.6%, and negative predictive value 82.1%; in the validation set, sensitivity was 61.3%, specificity 86.2%, positive predictive value 80.3%, and negative predictive value 70.8%.
Conclusions And Relevance:
Preoperative State-Trait Anxiety Inventory -Trait score, preoperative pain catastrophizing scale score, intraoperative remifentanil dose, and intraoperative or postanesthesia care unit dexmedetomidine use independently predict moderate-to-severe APP after orthognathic surgery. Our nomogram, a practical tool, enables early postoperative pain risk stratification, and guides individualized interventions to improve perioperative pain control.