Preoperative nomogram for predicting chronic postsurgical pain after arthroscopic rotator cuff repair

Chronic postsurgical pain (CPSP) is common after arthroscopic rotator cuff repair (ARCR). Preoperative risk assessment tools are lacking. This retrospective multicenter study included 1,509 ARCR patients (derivation cohort: n = 846, split 7:3 into training/internal validation; external validation: n = 663). Preoperative variables with p < 0.05 in baseline comparisons (CPSP vs. non-CPSP) were entered into multivariable logistic regression. Independent predictors were incorporated into a nomogram. Model performance was assessed by the area under the receiver operating characteristic curve (AUC), calibration, and decision curve analysis (DCA). Five preoperative factors—lower American Shoulder and Elbow Surgeons (ASES) score, elevated C-reactive protein, greater supraspinatus tendon retraction, and higher fatty infiltration grades of the supraspinatus and subscapularis muscles—were independently associated with CPSP. The nomogram showed good discrimination (AUC: training 0.87, internal validation 0.84, external validation 0.86), good calibration (Hosmer–Lemeshow p > 0.10), and positive net benefit on DCA. This multicenter nomogram provides a simple, non-invasive preoperative tool for CPSP risk stratification after ARCR and may help guide individualized perioperative pain management.