Factors Associated with Chronic Postsurgical Pain over 48 Months and Its Impact on Daily Activities After Cesarean Section in Brazil: A Prospective Cohort Study

Background/objectives: Cesarean delivery is common, and chronic postsurgical pain (CPSP) may persist, with limited evidence on associated factors and daily-life impact. This study aimed to identify factors associated with CPSP over 48 months of follow-up after cesarean section, to examine whether their associations changed over time, and to assess the impact of CPSP on women’s daily activities. Methods: This was a prospective cohort of 621 women undergoing cesarean section. Participants were assessed preoperatively and followed up at 7 days and 3, 6, 12, 24, 36, and 48 months. Intense acute pain at 7 days (numeric rating scale [NRS] ≥ 7) was assessed as a potential factor associated with CPSP, and CPSP was assessed at each follow-up from 3 to 48 months. Factors associated with CPSP were analyzed using GEE with binomial-logit models, a QIC-selected independent correlation structure, and robust standard errors. Sensitivity analyses addressed missing data, follow-up termination, and the 48-month assessment. Results: The cumulative incidence of CPSP was 25.5% at 3 months, and its prevalence was 5.7% (95% CI: 4.0–8.1) at 48 months. Across the 48 months, factors associated with CPSP included higher preoperative trait anxiety (adjusted OR = 1.06 per point; p = 0.002) and intense pain during the 7-day postoperative period (adjusted OR = 2.28; p < 0.001). These associations did not change over time and were similar in direction in sensitivity analyses. Conclusions: CPSP may persist for years after cesarean section and interfere with women’s activities. Trait anxiety and intense acute postoperative pain were associated with CPSP across the 48-month follow-up.