Beyond survival: Pain as the main determinant of long-term quality of life after thoracic trauma surgery

BACKGROUND Thoracic trauma is a major cause of trauma-related morbidity and mortality, often resulting from blunt mechanisms. While advances in acute management have improved short-term outcomes, long-term results-particularly health-related quality of life (QoL) after chest wall surgery-remain poorly defined. Identifying factors influencing long-term QoL is essential to optimize patient care. AIM To investigate long-term QoL and identify clinical factors influencing outcomes. METHODS Forty-one consecutive patients underwent chest wall surgery for thoracic trauma between November 2016 and November 2024 at our Hospital. Data collected for this retrospective cohort study included demographics, trauma characteristics, surgical details, postoperative complications, hospital and intensive care unit stay, and long-term patient-reported outcomes [EuroQol 5-Dimension 3-Level Questionnaire (EQ-5D-3 L), Numerical Rating Scale (NRS) for pain, and dyspnea scores]. Univariable and multivariable linear regression analyses were performed to identify predictors of QoL and pain. RESULTS At a median follow-up of 14 months (range 1-72), the median EQ-5D-3 L score was 0.68 (range 0.027-1), with no significant correlation with follow-up duration (Spearman’s rho = -0.05, P = 0.78). Pain was the only independent predictor of lower QoL (β = -0.079 per NRS unit, P = 0.016). Age, male gender, and comorbidities showed non-significant negative trends with QoL. For pain, a greater number of comorbidities was significantly associated with lower pain scores (β = -0.810, P = 0.041), while male sex was non-significantly associated with less pain. Dyspnea and perioperative variables were not significantly related to either outcome. CONCLUSION Long-term QoL after chest wall surgery is lower than the general population; pain is the main determinant. Effective pain control and comorbidity management are essential for personalized postoperative care.