“Unravelling the Pain: Exploring Incidence and Risk Factors for Chronic Postoperative Pain after Midline Laparotomies in Abdominal Cancer Surgery” a Prospective Observational Cohort Study

Background: Despite the well-documented incidence of chronic postsurgical pain (CPSP) in common surgical procedures, there is a significant gap in literature regarding its incidence and risk factors following major abdominal surgeries, particularly midline laparotomies for abdominal cancer. Materials and Methods: A prospective observational cohort study was conducted on 82 patients undergoing midline laparotomies over a period of 12 months and followed up to the completion of the 6 th month of surgery. Apart from the demographic data and treatment record, numerical rating scale (NRS) to record pain frequency and Douleur Neuropathic en 4 questions (DN4) and brief pain inventory (BPI) were used to know the quality of pain and its effect on daily functions. Results: A significant prevalence of CPSP was observed with 10.97% of patients reporting pain 4 months after surgery, which decreased to 6.1% at 6 months. Most of the patients complained of mild pain. Female sex, preoperative pain related to tumor, type of surgery, and radiation therapy were all found to have a statistically significant relationship with CPSP. A significant association was found between neuropathic pain (as assessed with DN4 Score) and persistent postsurgical pain with a P < 0.001. A significant improvement was observed only in general activity from 1 month to 6 months ( P = 0.02316), with no significant changes in mood, walking ability, normal work, relations with others, sleep, or enjoyment of life. Conversely, patients without CPSP experienced substantial reductions in pain interference in all BPI parameters from 1 month to both 4 th and 6 th months, indicating an overall improvement in daily functioning and quality of life. Conclusion: The results highlight the importance of addressing pain management comprehensively during the perioperative period, using multimodal strategies to reduce opioid use, and offering long-term pain support to those at risk of persistent pain.