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: Adolescent idiopathic scoliosis (AIS) patients frequently experience depressive symptoms, which may influence postoperative pain outcomes. However, high-quality prospective evidence remains scarce. This study aimed to investigate the association between preoperative depressive symptoms and postoperative pain trajectories in AIS. METHODS: This was a prospective study involving AIS patients aged 10-17 years who underwent surgical management for scoliosis correction under general anesthesia. Depressive symptoms, pain, functional activity, sleep quality, and quality of life were pre-operatively assessed using scales. Dynamic trajectories of acute postsurgical pain (APSP) and chronic postsurgical pain (CPSP) were evaluated during a 90-day follow-up. The primary outcome was the incidence of APSP. Secondary outcomes included the incidence of CPSP, oral morphine milligram equivalents (MME) during POD 1-5, early complications, postoperative length of stay, and long-term rehabilitation status. RESULTS: Preoperative depressive symptoms (odds ratio [OR] = 28.30), female sex (OR = 4.87), and a higher number of surgical segments (OR = 1.27) were identified as independent risk factors for CPSP. A risk prediction model (nomogram) constructed by incorporating the above variables effectively predicted CPSP in these patients, with an area under the curve (AUC) of 0.854 (95% confidence intervals [CI]: 0.774-0.934, P < 0.01). The incidence of CPSP was significantly higher in postoperative AIS patients with persistent depressive symptoms than those with relieved depression or persistently non-depressed symptoms (100% vs. 67.86% vs. 10.40%, P < 0.001). CONCLUSION: Preoperative depressive symptoms are risk factors for both APSP and CPSP in postoperative AIS patients, demonstrating a gradient association with the incidence of CPSP. A nomogram that incorporates female sex, the number of surgical segments, and preoperative depressive symptoms can effectively predict 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).