Chronic Postsurgical Pain-Induced Postoperative Anxiety Risk

Objective: To evaluate whether chronic postsurgical pain (CPSP) is independently associated with an increased risk of postoperative anxiety in patients undergoing major surgery. Methods: This retrospective cohort study analyzed data from Taiwan’s National Health Insurance Research Database (NHIRD), including 134,726 patients who underwent major surgery between 2004 and 2020. Propensity score matching (PSM) was employed to balance baseline characteristics between CPSP and non-CPSP groups. Multivariate Cox proportional hazards models and competing risk analyses were used to assess the association between CPSP and postoperative anxiety. Results: Before matching, patients with CPSP had a significantly increased risk of developing anxiety compared to those without CPSP (adjusted hazard ratio [aHR], 1.49; 95% confidence interval [CI], 1.45–1.53). This association remained robust after PSM (aHR, 1.48; 95% CI, 1.43–1.53). Sensitivity analyses across various models confirmed the consistency of this association. Conclusions: CPSP is an independent and clinically relevant predictor of postoperative anxiety. These findings underscore the need for early identification and targeted management of CPSP to reduce the psychological burden after major surgery and improve overall perioperative care outcomes.