Identification of risk factors and development of predictive models for chronic postsurgical pain after modified radical mastectomy.

OBJECTIVE

To investigate the risk factors for chronic postsurgical pain (CPSP) following modified radical mastectomy (MRM) for breast cancer and to establish a clinical prediction model.

METHODS

A prospective cohort study was conducted, enrolling patients who underwent MRM for breast cancer. Comprehensive data were systematically collected at three time points: preoperatively, intraoperatively, and postoperatively. Follow-up assessments were performed at 3 and 6 months postoperatively. Separate prediction models were constructed for CPSP at 3 months and 6 months postoperatively. A comprehensive clinical prediction model was developed through a systematic approach.

RESULTS

A total of 235 patients were enrolled in this study. Postoperative insomnia and follicle-stimulating hormone (FSH) levels were independent risk factors for CPSP at both 3 and 6-month postoperatively, while a higher body mass index (BMI) was a protective factor for CPSP at 3-month postoperatively. The AUC values of the model at 3 and 6-month postoperatively were 0.767 (0.706-0.829) and 0.733 (0.666-0.799), respectively. Model performance and stability were further confirmed by receiver operating characteristic (ROC) curves, decision curve analysis (DCA), calibration curves, and a nomogram, indicating good discrimination and clinical applicability.

CONCLUSION

Postoperative insomnia and FSH levels are independent risk factors for CPSP at 3 and 6-month postoperatively, and a higher BMI is a protective factor for CPSP at 3-month postoperatively. Early identification and management of postoperative insomnia, as well as preoperative screening of FSH levels, may help reduce the risk of CPSP.