Conference Coverage

Preoperative Distress Linked to Pain After Ambulatory Mastectomy

Edited by:
Ashton L. Stahl

Key Highlights

  • Preoperative distress was reported by 49% of 1281 patients.
  • Pain clinic referrals occurred in 8.7% of patients with distress versus 5.4% without distress.
  • Distress was associated with several adverse recovery outcomes in univariable analyses, but the adjusted referral association did not reach statistical significance.

Preoperative psychological distress was associated with greater post-discharge pain severity and more pain clinic referrals after ambulatory mastectomy with immediate reconstruction, according to a retrospective study presented at the ANESTHESIOLOGY Annual Meeting 2026 in San Diego.

Researchers evaluated 1281 patients who underwent ambulatory mastectomy with immediate reconstruction between August 2022 and June 2024. Records involving repeat procedures, reoperation, chronic pain history, or missing preoperative outcomes were excluded. Routine preoperative screening assessed distress, anxiety, and depression; clinically significant distress was defined as a Distress Thermometer score of at least 4 within 6 months of surgery.

The primary outcome was any pain clinic referral within 6 months. Secondary outcomes included post-anesthesia care unit opioid use and length of stay, 30-day urgent care visits, post-discharge severe pain, and modified Quality of Recovery–15 scores. Researchers compared outcomes by distress status and used multivariable logistic regression to adjust the referral analysis for anxiety and other clinically relevant covariates. Depression was excluded from the model because of its association with distress and anxiety.

Study Findings

Overall, 632 patients, approximately 49%, reported preoperative distress. Among patients with distress, 41% had anxiety, and 20% had depression. Ninety patients received a pain clinic referral: 55 of 632 patients with distress (8.7%) and 35 of 649 without distress (5.4%; P = .020). Univariable analyses also linked distress to higher postoperative opioid use, greater post-discharge pain severity, worse quality of recovery, and more frequent urgent care visits.

In the adjusted analysis, patients with distress alone had an odds ratio for referral of 1.62 (95% CI, 0.96–2.73), compared with patients reporting neither distress nor anxiety. Corresponding odds ratios were 3.24 (95% CI, 0.72–10.4) for anxiety alone and 1.77 (95% CI, 1.00–3.09) for distress with anxiety. The overall association did not reach statistical significance (P = .08).

Clinical Implications

According to the study authors, these findings add to evidence linking psychosocial factors with post-discharge pain, recovery, and health care utilization. Although referral rates differed significantly in the unadjusted comparison, the adjusted findings did not establish a statistically significant association. The authors called for further research evaluating whether treating distress reduces the need for post-discharge pain care.

Expert Commentary

“Future studies should evaluate whether treating distress reduces need for post-discharge pain care,” the researchers concluded.

Reference

Zisa A, Serafin J, Lee J, et al. Preoperative distress and postoperative pain after ambulatory mastectomy with immediate reconstruction. Abstract to be presented at: ANESTHESIOLOGY 2026; October 16-20, 2026; San Diego, CA. Abstract A1012.