Association of Posttraumatic Growth and Analgesic Use in Postoperative Patients

Posttraumatic growth (PTG) refers to positive psychologic changes experienced after traumatic events. The Posttraumatic Growth Inventory-Expanded (PTGI-X) measures PTG across five subscales, with higher scores indicating greater PTG. This study investigated factors influencing postoperative PTGI-X score and its impact on postoperative analgesic use and quality of life.

This prospective observational study enrolled adult patients scheduled for chest surgery for malignant mediastinal and lung tumors, excluding those with previous psychologic disorders, severe obesity, or cognitive impairment. PTGI-X, Hospital Anxiety and Depression Scale (HADS), European Quality of Life five-dimension three-level (EQ-5D-3L) questionnaire, and Brief Pain Inventory were used for assessments. PTGI-X was measured 30 days after surgery, HADS was measured before surgery, EQ-5D-3L was measured before and 30 days after surgery, and Brief Pain Inventory was assessed at variable pre- and postsurgery time points within 30 days. Linear regression analyses were performed to explore perioperative factors associated with PTGI-X score as the primary outcome. Secondary outcomes included logistic regression analysis with PTGI-X score as the explanatory variable for the need of postoperative analgesic medication on day 30, as well as linear regression analysis with PTGI-X score as the explanatory variable for changes in EQ-5D-3L scores.

Of 144 eligible patients, 120 completed the 1-month follow-up. Median PTGI-X score was 56.5 (interquartile range, 37.5, 76). Preoperative anxiety (HADS subscale for anxiety, 8 or greater) was significantly associated with PTGI-X score (coefficient, 17.12; 95% CI, 5.44 to 28.81). PTGI-X score (odds ratio, 0.76; 95% CI, 0.62 to 0.94) and significant postoperative pain were independently associated with postoperative analgesic medication. PTGI-X score was not associated with EQ-5D-3L scores.

Patients experienced PTG after surgery, and preoperative anxiety was associated with greater PTG as measured by PTGI-X. Greater PTGI-X was associated with reduced odds of analgesic use 30 days after surgery. Interventions to enhance postoperative PTG might lead to better postoperative health outcomes.