SP37. Impact of Depression and Anxiety on Chronic Postoperative Pain in Autologous Breast Reconstruction: A Propensity-Score Match Analysis

PURPOSE: Autologous breast reconstruction (ABR) has become the standard for breast cancer survivors and plays a crucial role in their overall well-being after treatment. Although ABR is associated with relatively low complication rates, the increasing prevalence of postoperative pain is concerning for its association with clinical morbidity and disability. While recent studies have identified psychiatric disorders as potential risk factors for postoperative pain following mastectomy, little is known about their specific impact on breast reconstruction patients. Therefore, this study aims to evaluate the influence of major depressive disorder (MDD) and generalized anxiety disorder (GAD) on the development of chronic postoperative pain syndromes in patients undergoing ABR. METHODS: A retrospective analysis was conducted using TriNetX, a large multicenter, national, de-identified database, encompassing data from 54 healthcare institutions. The study population consisted of patients who underwent ABR. Two cohorts were created: one of patients with a previous psychiatric diagnosis of MDD or GAD, and the other without either diagnosis. A 1:1 propensity score matching was performed based on 14 baseline characteristics, including sociodemographics and comorbidities such as pre-existing pain disorders. The primary outcome was the incidence of chronic postoperative pain at multiple time points. Additionally, postoperative complications and healthcare utilization within 90 days of the index procedure were assessed. Group differences were analyzed using t-tests and chi-square tests, and logistic regression models were applied to evaluate outcome differences between the groups. RESULTS: A total of 17,852 patients undergoing ABR were identified, of whom 7,501 (42%) had a diagnosis of either MDD, GAD, or both. Following propensity score matching, 8,846 patients were included, with 50% in each group. Patients with MDD or GAD had higher odds of developing chronic postoperative pain at 6 months (OR 1.212; 95% CI 1.046-1.406; p=0.020), 1 year (OR 1.298; 95% CI 1.190-1.417; p<0.001), 3 years (OR 1.284; 95% CI 1.204-1.370; p<0.001), and 5 years (OR 1.259; 95% CI 1.189-1.334; p<0.001) compared to patients without psychiatric diagnoses. There were no significant differences in the odds of acute postoperative pain between the cohorts. Interestingly, patients with psychiatric diagnoses exhibited lower rates of 90-day wound dehiscence (4.1% vs. 5.2%; p=0.018). Differences in postoperative healthcare utilization and other complications, such as flap failure, were not significant between the groups. CONCLUSION: Patients with MDD or GAD are at significantly higher risk of developing chronic postoperative pain following ABR, and this risk increases over time. Early identification of high-risk patients is critical for timely referral, monitoring, and targeted interventions to mitigate morbidity and disability. Further research is needed to explore additional risk factors contributing to chronic postoperative pain in patients with psychiatric comorbidities.