Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
Beyond survival: Pain as the main determinant of long-term quality of life after thoracic trauma surgery
Federico Raveglia, Sara Degiovanni, Luca Bertolaccini, Andrea Cara, Enrico Mario Cassina, Federica Danuzzo, Lidia Libretti, Emanuele Pirondini, Maria Chiara Sibilia, Francesca Spinelli, Antonio Tuoro, Matilde De Simone, Marco Chiarelli, Ugo Cioffi, Francesco Petrella
Federico Raveglia, Sara Degiovanni, Andrea Cara, Enrico Mario Cassina, Federica Danuzzo, Lidia Libretti, Emanuele Pirondini, Maria Chiara Sibilia, Francesca Spinelli, Antonio Tuoro, Francesco Petrella, Department of Thoracic Surgery, IRCCS San Gerardo dei Tintori, Monza 20900, Lombardy, Italy
Luca Bertolaccini, Department of Thoracic Surgery, European Institute of Oncology, Milan 20141, Lombardy, Italy
Luca Bertolaccini, Department of Oncology and Hemato-Oncology, University of Milan, Milan 20137, Lombardy, Italy
Matilde De Simone, Ugo Cioffi, Department of Surgery, University of Milan, Milan 20122, Lombardy, Italy
Marco Chiarelli, Department of Emergency and Robotic Surgery, S. Leopoldo Mandic Hospital, Merate 23807, Lombardy, Italy
Author contributions: Raveglia F, Petrella F performed the conceptualization; Raveglia F, Danuzzo F performed writing-original draft; Raveglia F, Bertolaccini L, Degiovanni S, Petrella F performed writing-review and editing; Bertolaccini L, Cara A, Danuzzo F, Libretti L, Pirondini E, Sibilia MC, Spinelli F, Degiovanni S, De Simone M, Chiarelli M, Cioffi U performed data curation; Bertolaccini L performed formal analysis; Bertolaccini L, Petrella F performed supervision; Cassina EM, Spinelli F, Degiovanni S, Tuoro A, Petrella F performed investigation; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the IRCCS San Gerardo dei Tintori Institutional Review Board (No. 4594).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors report no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Data available on request.
Corresponding author: Sara Degiovanni, MD, Department of Thoracic Surgery, IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, Monza 20900, Lombardy, Italy.
sara.degiovanni@unimi.it
Received: February 2, 2026
Revised: March 9, 2026
Accepted: April 1, 2026
Published online: May 6, 2026
Processing time: 80 Days and 16.9 Hours
BACKGROUND
Thoracic trauma is a major cause of trauma-related morbidity and mortality, often resulting from blunt mechanisms. While advances in acute management have improved short-term outcomes, long-term results-particularly health-related quality of life (QoL) after chest wall surgery-remain poorly defined. Identifying factors influencing long-term QoL is essential to optimize patient care.
AIM
To investigate long-term QoL and identify clinical factors influencing outcomes.
METHODS
Forty-one consecutive patients underwent chest wall surgery for thoracic trauma between November 2016 and November 2024 at our Hospital. Data collected for this retrospective cohort study included demographics, trauma characteristics, surgical details, postoperative complications, hospital and intensive care unit stay, and long-term patient-reported outcomes [EuroQol 5-Dimension 3-Level Questionnaire (EQ-5D-3 L), Numerical Rating Scale (NRS) for pain, and dyspnea scores]. Univariable and multivariable linear regression analyses were performed to identify predictors of QoL and pain.
RESULTS
At a median follow-up of 14 months (range 1-72), the median EQ-5D-3 L score was 0.68 (range 0.027-1), with no significant correlation with follow-up duration (Spearman’s rho = -0.05, P = 0.78). Pain was the only independent predictor of lower QoL (β = -0.079 per NRS unit, P = 0.016). Age, male gender, and comorbidities showed non-significant negative trends with QoL. For pain, a greater number of comorbidities was significantly associated with lower pain scores (β = -0.810, P = 0.041), while male sex was non-significantly associated with less pain. Dyspnea and perioperative variables were not significantly related to either outcome.
CONCLUSION
Long-term QoL after chest wall surgery is lower than the general population; pain is the main determinant. Effective pain control and comorbidity management are essential for personalized postoperative care.
Core Tip: Long-term outcomes after surgical stabilization of thoracic trauma are poorly characterized. This study shows that health-related quality of life (QoL) remains lower than in the general population even months after surgery. Pain emerged as the only independent predictor of worse long-term QoL, whereas perioperative and trauma-related variables were not significantly associated. Comorbidities influenced pain perception, underscoring their role in recovery. These findings emphasize the need for tailored long-term follow-up strategies focused on pain control and comprehensive management of comorbidities to improve patient outcomes after thoracic trauma surgery.
