Predisposing Factors for Chronic Post-Surgical Pain After Thoracic Surgery: A Scoping Review with Quantitative Synthesis.

BACKGROUND

Chronic post-surgical pain (CPSP) is a frequent complication after thoracic and cardiothoracic surgery; however, reported risk factors remain heterogeneous and inconsistent.

OBJECTIVE

To map and synthesize the factors associated with CPSP after thoracic and cardiac surgery and to determine the strength of evidence supporting each predictor category.

METHODS

An exploratory review was conducted following PRISMA-ScR guidelines. Searches were performed in PubMed, Scopus, and Web of Science, identifying 20 eligible studies. A complementary qualitative synthesis was undertaken: statistically significant p-values (p < 0.05) were extracted, and predictors were categorized by evidence strength (strong, moderate, limited/inconsistent).

RESULTS

Severe acute postoperative pain during the first postoperative days emerged as the strongest and most reproducible predictor of CPSP across designs and populations. Psychological distress, particularly anxiety, depression, and catastrophizing, also showed strong and consistent associations. Moderate evidence supported the influence of young age, female sex, low BMI, and pre-existing chronic pain. Surgical determinants such as operative duration, minimally invasive approaches, tissue trauma, and postoperative complications showed variable associations, as did anesthetic factors, especially high intraoperative remifentanil doses. Evidence for single-dose S-ketamine and regional blocks was limited or inconsistent. Preliminary findings related to inflammatory cytokines, microRNA phenotypes, and geriatric prediction models suggest additional biological contributors but remain exploratory.

CONCLUSION

CPSP after thoracic and cardiothoracic surgery results from interacting nociceptive, psychological, procedural, and biological factors. Although heterogeneity across studies requires cautious interpretation, this synthesis highlights early postoperative pain control and psychological vulnerability screening as priority strategies in perioperative care, and underscores the need for standardized, prospective, biomarker-informed research.