Gender Differences in Postoperative Pain Following Long-Bone Fracture Surgery: A Retrospective Observational Study
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Background: Postoperative pain is common after orthopedic trauma surgery and may delay mobilization, impair rehabilitation, and increase the risk of persistent postsurgical pain. Sex-based differences in pain perception have been reported in several surgical populations, but local evidence among patients undergoing long-bone fracture surgery remains limited. Objective: To evaluate postoperative pain severity after long-bone fracture surgery and determine whether sex and perioperative clinical factors were associated with moderate-to-severe postoperative pain. Methods: This retrospective observational analytical study included 433 adult patients who underwent long-bone fracture surgery at Ghurki Trust Teaching Hospital, Lahore, from May 2025 to December 2025. Data were extracted from medical records, surgical notes, anesthesia records, and postoperative monitoring charts. Postoperative pain was measured using VAS/NRS and categorized as mild pain (0–3) or moderate-to-severe pain (4–10). Demographic, injury-related, surgical, anesthetic, and analgesic variables were analyzed using descriptive statistics, subgroup comparisons, and planned logistic regression. Results: Among 433 patients, 245 (56.6%) were male and 188 (43.4%) were female. Moderate-to-severe postoperative pain was reported by 241 patients (55.7%), while 192 (44.3%) reported mild pain. Female patients had higher median pain scores than male patients (6.0 vs 4.0). Higher median pain scores were also observed among patients with preoperative opioid exposure (7.0 vs 4.0), displaced fractures (6.0 vs 4.0), delayed surgery beyond 24 hours (6.0), and road traffic accident-related injuries (6.0). Conclusion: Moderate-to-severe postoperative pain was frequent after long-bone fracture surgery. Female sex and selected perioperative characteristics showed clinically relevant associations with higher pain burden, supporting early risk stratification and individualized multimodal analgesic planning
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