Authors: Zhu Y et al.
Source: Anesthesia & Analgesia. January 23, 2026.
Summary:
Chronic postsurgical pain (CPSP) remains a major but incompletely understood complication following fracture repair, particularly in younger patients with distal lower extremity fractures. In this prospective cohort study, Zhu and colleagues evaluated the incidence of CPSP and developed a validated prediction model to identify high-risk patients early in the postoperative course.
The investigators followed 818 patients for one year after surgery. CPSP at 3 months occurred in 38.4% of patients, with nearly one-fifth of those developing neuropathic pain features. Using a three-stage modeling strategy that combined machine learning variable selection (LASSO and information gain analysis) with multivariable logistic regression, six independent predictors of CPSP were identified. These included postoperative analgesic technique, fixation type, preoperative clinical management, pain catastrophizing score (PCS), and numerical rating scale (NRS) pain scores at admission and on postoperative day one.
The resulting model demonstrated strong predictive performance, with optimism-corrected AUCs of 0.872 in the development cohort and 0.838 in the validation cohort, along with good calibration and clinical utility. To improve real-world usability, the authors translated the final model into a web-based nomogram hosted on a Shinyapps.io platform, allowing CPSP risk estimation at the time of hospital discharge.
What You Should Know:
• CPSP after distal lower extremity fracture surgery is common, affecting more than one-third of patients.
• Early postoperative pain intensity and pain catastrophizing are powerful predictors of chronic pain development.
• Surgical factors and analgesic strategies meaningfully influence long-term pain outcomes, underscoring the role of anesthesiologists in CPSP prevention.
• A validated, web-based prediction tool may help identify high-risk patients early and facilitate targeted transitional pain care interventions.
Key Points:
• CPSP incidence at 3 months was 38.4% in this cohort.
• Six clinically accessible predictors were independently associated with CPSP.
• The prediction model showed strong discrimination and validation performance.
• Early risk stratification may support personalized perioperative pain management strategies.
Thank you to Anesthesia & Analgesia for publishing this important work advancing early identification and prevention strategies for chronic postsurgical pain.