Authors: Gianluca Pellino Francesco Selvaggi
Publish Date: 2015/01/20
Volume: 30, Issue: 10, Pages: 1437-1437
Abstract
We read with interest the letter by Tin et al 1 commenting on our paper dealing with a score to predict pain after excisional hemorrhoidectomy 2 recently published in the International Journal of Colorectal Disease We thank the authors for their observations which offered us the opportunity of giving some explanationsConcerning the two scores to predict postoperative pain suggested by Tin et al we did not compare our score with these for different reasons First only one is dealing with earlyonset high pain after surgery Boselli et al whereas the other one is focused on chronic pain Althaus et al As clearly stated in our manuscript we did not develop a score to predict prolonged pain due to the limited number of observed events 2 Second one should consider that these scores are developed on a heterogeneous group of patients undergoing different types of surgical procedures eg only 11 out of 245 patients 45 received surgery for abdominal diseases in one paper Althaus et al Pain can occur after any type of surgery but it is the most common complication after hemorrhoid surgery 2 and it is perceived as a major issue by patients with piles In addition the psychological distress which may be observed in patients diagnosed with malignancies undergoing multimodal treatments or repeated surgery 3 might play a role in postoperative pain perception making it difficult to obtain reasonable comparisons This also leads us to exclude from our model patients undergoing procedures that were more complex than pure excisional hemorrhoidectomy 2Regarding the process of validation used for our score it is not dissimilar from that reported in most studies aimed at developing predictive scores As we clearly stated 2 sample size calculations were made before developing the score and discrimination as well as goodnessoffit were tested by means of accepted methods 2 Furthermore we provided a figure comparing directly the reliability of the score in development and validation group Besides an external validation would be desirable and likely to come to the point 4
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