Can a Blood Test of Immune Responsiveh. Speed of Recovery from Pain and Dysfunction afterSurgery?

摘要

THE current issue contains a remarkable report on a blood test to predict how quickly patients recover from surgery.1 This and other medical journals are full of predictive tests and tools for a good reason-doctors and patients are interested in what to expect from disease and treatment (see, for example, a Web-based tool to predict your own likelihood of dying in the next 5 yr at www.ubble.co.uk/ risk-calculator). In addition to more informed decision-making, better prediction is key to more targeted prevention, speedier diagnosis, more effective treatment, and better understanding of mechanisms of disease. Better predictive tools for morbidity and mortality after surgery are particularly needed, given the high risk of death and permanent disability in the perioperative period beyond the operating room doors. The report by Fragiadakis et al. is remarkable for several reasons: its focus on patient-centered outcomes; an exciting, innovative hypothesis; and the unexpected strength of the predictor it uncovers. Let us briefly review each. Recovery from Surgery as a Primary Outcome Most patients understand that surgery will cause temporary pain, dysfunction, and disability. They consider these burdens to be acceptable, provided the disability is not too great or lasts too long. We know surprisingly little beyond the broad strokes of this recovery process—considerable disability and pain for a few days, somewhat better in a few weeks, and most likely gone in a few months. What little we do know relies on cross-sectional incidence data with infrequent assessments— pain present yes or no at 2, 6, or 24 weeks, for example. This data-poor approach does little to help patients understand how quickly they will recover and may well mislead the study of mechanisms of recovery. An alternative approach, exemplified in the recent validation of an assessment tool to define disability-free survival after surgery,3 examines both severity and time course of dysfunction. The current study1 is one of the first to examine patient-centered outcomes at frequent intervals during the period of rapid recovery.