The Impact of Preoperative Depressive Symptoms on Acute and Chronic Postoperative Pain Trajectories After Orthopedic Surgery for Adolescent Idiopathic Scoliosis: a Prospective Cohort Study

Background: Patients with adolescent idiopathic scoliosis (AIS) frequentlyexperience depressive symptoms, and their functional rehabilitation can be greatly influenced by postoperative acute and chronic pain. This study aims to explore the association ofpreoperative depressive symptoms in AIS patients with postoperative acute and chronic pain. Methods: This was a prospective study involving AIS patients aged 10-17 years who were surgically managed by scoliosis correction under general anesthesia. Depressive symptoms, pain, functional activity, sleep quality, and quality of life were preoperatively assessed using scales. Dynamic trajectories in the acute postsurgical pain (APSP) and chronic postsurgical pain (CPSP) were evaluated during a 90-day follow-up. The primary outcomes were the incidence of APSP and CPSP. Secondary outcomes consisted of early postoperative oral morphine milligram equivalents (MME), early complications, postoperative length of stay, and long-term rehabilitation status. Results: Multivariate analysis identified that female sex (odds ratio [OR]=6.36, P <0.05), number of surgical segments (OR=1.31, P <0.01), and preoperative depressive symptoms (OR=41.06, P <0.001) wereindependent risk factors for CPSP. A risk prediction model (nomogram)constructed by incorporating the above variables effectively distinguished CPSP in postoperative AIS patients, with an area under the curve (AUC) of 0.852 (95% confidence intervals [CI]: 0.786–0.918, P <0.01). The incidence of CPSP was significantly higher in postoperative AIS patients with persistent depressive symptoms than those with relieved or cured depressive symptoms (100% vs. 67.86% vs. 10.40%, χ²=50.46, P <0.001). Conclusions: Preoperative depressive symptoms are risk factors for both APSP and CPSP in postoperative AIS patients, showing a gradient association with the incidence of CPSP. A nomogram incorporating female sex, number of surgical segments, and preoperative depressive symptoms effectively predicts CPSP in this population. An integrative psychological and analgesic intervention centered on preoperative depressive symptoms is expected to benefit high-risk AIS patients. Trial registration: According to the Helsinki Declaration,the research protocol has been registered with the Chinese Clinical Trial Registry (ChiCTR; https://www.chictr.org.cn/) (Registration No: ChiCTR2300077637).