Trajectory of acute postoperative pain and influencing factors in patients with esophageal cancer: A prospective study.

PURPOSE: Acute postoperative pain after esophageal cancer surgery is highly prevalent and hinders rehabilitation. This study explores the trajectory and influencing factors of acute postoperative pain to guide targeted pain management. METHODS: A prospective design was adopted among 200 patients who had undergone esophageal cancer surgery in a tertiary hospital in Nanjing, China, from June to November 2025. Pain was assessed via the Numerical Rating Scale across 11 postoperative time-points (1 h after surgery, 8 a.m. and 8 p.m. from day 1 to 5 after surgery). Latent class growth analysis identified pain trajectories, while logistic regression and decision tree models evaluated influencing factors. RESULTS: Two distinct pain trajectories were identified, i.e., a mild-pain-stable group (81.0%) and a pain-exacerbated-then-relieved group (19.0%). Logistic regression identified smoking, drinking, preoperative sleep disorders, preoperative pain history, and chest tube indwelling time as significant predictors (P < 0.05). The decision tree model identified smoking, drinking, preoperative sleep disorders, and chest tube indwelling time as core variables, with chest tube duration showing the strongest correlation. Both models demonstrated promising preliminary predictive performance (Logistic regression AUC = 0.931; Decision tree AUC = 0.893), though these findings require external validation. CONCLUSION: Acute postoperative pain trajectories in esophageal cancer patients exhibit clear population heterogeneity. These preliminary findings suggest that the identified risk factors may inform targeted analgesic interventions in future study designs, but prospective validation in independent cohorts is warranted before clinical implementation.