Narrow intercostal anatomy is associated with early postoperative pain after thoracoscopic surgery.

PURPOSE: This study retrospectively investigated the risk factors for postoperative pain after thoracoscopic surgery, with a particular focus on chest wall anatomical characteristics. METHODS: We reviewed patients who underwent thoracoscopic surgery between August 2021 and June 2025 at our institution. At routine outpatient visits 2-3 weeks after discharge, postoperative pain was assessed using the Numerical Rating Scale. Patients were categorized into a pain group (score ≥ 3) and a low-pain group (score ≤ 2). Clinical variables, perioperative factors, and preoperative chest wall anatomy were compared using an imaging analysis workstation. RESULTS: Among the 149 patients, 62 (41.6%) reported a score of ≥ 3. The pain group showed a higher prevalence of habitual anxiolytic use, a greater proportion of patients with obstructive ventilatory impairment, narrower intercostal spaces, and longer operative time (all p < 0.05). In multivariable logistic regression analysis, a sixth intercostal space width of ≤ 10.2 mm was associated with postoperative pain (odds ratio 3.69, 95% confidence interval 1.510-8.990, p = 0.004). CONCLUSIONS: This study provides the first evidence that narrow intercostal anatomy is a significant risk factor for early postoperative pain after thoracoscopic surgery. Our novel insights may enhance preoperative risk stratification and support individualized analgesic strategies.