Subacute postoperative pain after esophagectomy: a high-volume single-centre retrospective cohort study of longitudinal pain trajectory analysis

Subacute postsurgical pain (SPSP) after esophagectomy remains poorly characterised, particularly regarding early postoperative pain trajectories. This study aimed to estimate the prevalence of SPSP 1 month after esophagectomy, identify associated factors and compare early postoperative pain trajectories. This single-centre, observational retrospective cohort study included adult patients undergoing elective esophagectomy for cancer between 2022 and 2024. Primary outcome was SPSP at 1 month defined as numerical rating scale (NRS) ≥ 3. Multivariable logistic regression model was used to identify factors associated with SPSP at 1 month. Early postoperative pain trajectories were analysed using mixed model for repeated measures. Among 241 included patients, 82 patients reported SPSP at 1 month (34.0%, 95% CI 28.1% to 40.4%). Neuropathic pain features were highly prevalent among patients with SPSP at 1 month (86.6% versus 1.3%). Younger age ( p = 0.006) and higher Pain Catastrophizing Scale scores ( p < 0.001) were independently associated with SPSP at 1 month, whereas major complications were inversely associated ( p = 0.002). Mixed models showed that patients with SPSP had consistently higher pain scores from the early postoperative period onward (mean difference 1.64, 95% CI 1.29 to 1.98; p < 0.001), while pain decreased over time in both groups ( p < 0.001) without statistically significant difference in their trajectories (interaction p = 0.056). SPSP one month after esophagectomy is associated with a higher early postoperative pain burden rather than altered pain resolution. These findings support the implementation of systematic follow-up and early, targeted interventions, particularly within a transitional pain framework, to prevent pain the evolution toward chronic pain after esophagectomy.