Association Between Preoperative Psychological Symptoms and Chronic Postsurgical Pain in Older Patients Undergoing off-Pump Coronary Artery Bypass Grafting: Mediation Analysis of Acute Pain.

Abstract

Purpose: This study aimed to investigate the association between preoperative psychological symptoms and chronic postsurgical pain (CPSP) in older patients undergoing off-pump coronary artery bypass grafting, and explore the mediating effect of acute postsurgical pain.

Patients and methods: A total of 172 patients aged ≥60 years, undergoing off-pump CABG were enrolled. Preoperative anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Acute pain intensity was recorded daily (postoperative days 1-5), with time-weighted average (TWA) scores calculated. CPSP was defined as persistent pain at 3 months after surgery. Logistic regression evaluated associations between preoperative psychological symptoms (individually and by stratification) and CPSP. Mediation analysis explored the role of acute pain between preoperative psychological factors and CPSP.

Results: Prevalence of CPSP was 37.8% (29.1% mild, 8.7% moderate-to-severe). CPSP patients exhibited higher female proportion (36.9%, P=0.012), precordial pain (56.9%, P=0.044), anxiety (46.2%, P<0.001), depression (35.4%, P<0.001), and TWA scores (4.0 vs 3.0, P<0.001). Preoperative anxiety (OR = 3.64, P = 0.002) and depression (OR = 3.26, P = 0.004) independently predicted CPSP, with comorbid symptoms conferring higher risk (OR = 7.83, P = 0.002). Acute pain partially mediated anxiety-CPSP association (indirect effect: 7.7%; P = 0.002).

Conclusion: Preoperative anxiety and depression elevate CPSP risk in older off-pump CABG patients. Acute postsurgical pain partially mediates the anxiety-CPSP relationship. Integrated perioperative strategies targeting psychological health and pain management are critical to mitigate long-term pain outcomes.