Risk factors and development of a predictive nomogram model for acute postoperative pain in oral cancer

This study aimed to determine the incidence and independent factors of acute postoperative pain in oral cancer patients and develop an individualized predictive nomogram. A retrospective cohort study included 458 oral cancer patients who underwent tumor resection with free flap reconstruction at Wuhan University’s Hospital of Stomatology (January 2023–December 2024). Demographics, medical history, tumor features, surgical variables, and preoperative anxiety/depression were collected. Pain intensity was assessed using the Numerical Rating Scale (NRS) on postoperative days 1, 2, 3, and 7. Independent risk factors were identified via multivariate analysis, and a nomogram was validated using Receiver operating characteristic (ROC) curves, calibration curves, and Decision Curve Analysis ( DCA). The incidence of acute pain on postoperative day 3 was 74.67% (342/458), with 51.53% experiencing moderate pain (NRS 4–6) and 17.25% severe pain (NRS ≥ 7). Independent factors included education ≤junior high school (OR = 0.29), no history of immunotherapy (OR = 0.12), larger tumor volume (OR = 20.53), unilateral (OR = 3.46) or bilateral lymph node dissection(OR = 10.95), free flap type(OR = 10.17), and preoperative anxiety/depression (OR = 2.71; all P < 0.05).The nomogram showed excellent performance (AUC = 0.923; training/validation sets: 0.928/0.911), with high consistency between predicted and actual incidence (Hosmer-Lemeshow test, P > 0.05) and significant clinical net benefits (DCA). In conclusion, acute postoperative pain in oral cancer is common and multifactorial. The nomogram accurately predicts this risk, aiding individualized analgesia and optimizing pain management.