2026 FSA Podium and Poster Abstracts

Introduction: Chronic pain following breast surgery is a common and challenging complication, with reported incidence ranging from 15% to over 40%. Preoperative depression has been identified as a potential risk factor for developing chronic postsurgical pain, though findings across studies remain inconsistent due to small sample sizes and variable definitions. Existing meta-analyses suggest a modest association between depression and prolonged pain after major surgery, but the certainty of evidence is limited. Large-scale, real-world data analyses are needed to clarify this relationship. This study aimed to evaluate the incidence of chronic pain after breast surgery among patients with and without preoperative depression using a multi-institutional electronic health record network.

Methods: We conducted a retrospective cohort study using the TriNetX Research Network to identify adult female patients who underwent breast surgery. Two cohorts were created based on the presence or absence of a preoperative depression diagnosis. The index event was the date of breast surgery, and outcomes were assessed from 90 to 365 days postoperatively. The primary outcome was chronic pain, with secondary outcomes including opioid use, gabapentin use, and nerve block procedures. Patients with these outcomes before the analysis window were excluded. Risk ratios, odds ratios, and 95% confidence intervals were calculated using TriNetX’s built-in Measures of Association and Kaplan–Meier analyses.

Results: Among 1,053,881 adult female patients who underwent breast surgery, 129,451 (12.3%) had a preoperative diagnosis of depression. After excluding patients with preexisting outcomes, 66,589 patients with depression and 746,067 without depression were analyzed for chronic pain incidence. Chronic pain occurred in 7.3% of patients with depression compared to 3.2% without depression (risk ratio 0.43, 95% CI 0.42–0.45; p < 0.001). Opioid use between 90–365 days postoperatively was higher among patients with depression (13.6% vs 9.2%; RR 0.67, 95% CI 0.65–0.70; p < 0.001). Gabapentin use was also more frequent in the depression cohort (5.4% vs 3.1%; RR 0.57, 95% CI 0.55–0.59; p < 0.001), as were nerve block procedures (1.5% vs 0.8%; RR 0.50, 95% CI 0.47–0.52; p < 0.001). Kaplan–Meier analysis demonstrated lower pain-free survival at 12 months for patients with depression across all outcomes (log-rank p < 0.001).

Conclusion: Preoperative depression was associated with a significantly higher incidence of chronic pain, opioid use, gabapentin use, and nerve block procedures following breast surgery. These findings suggest that depression is an important psychosocial risk factor for chronic postsurgical pain and pain-related healthcare utilization. Enhanced preoperative screening and multidisciplinary perioperative management of patients with depression may help reduce the burden of chronic pain after breast surgery.