Abstract: Objective To analyze the incidence of acute postoperative pain in patients with stage Ⅲ tuberculous empyema and its influencing factors. Method A retrospective analysis was conducted on the clinical data of 105 patients with stage Ⅲ tuberculous empyema who underwent surgical treatment at the Department of Thoracic Surgery, Public Health Clinical Center of Chengdu, from June 2023 to April 2025. Pain levels were assessed using the numeric rating scale (NRS) and categorized into a pain group (NRS score≥4, n=46) and a control group (NRS score<4, n=59). Postoperative acute pain within the first three days was evaluated using the NRS for both groups. Using binary logistic regression analysis was used to investigate the influencing factors of acute postoperative pain in patients with stage Ⅲ tuberculous empyema. Result The incidence of postoperative acute pain in patients with stage Ⅲ tuberculous empyema was 43.81%. Univariate analysis revealed significant differences in gender, alcohol consumption, pleural thickness, surgical method, operation duration, and postoperative drainage volume between the pain group and the control group (P<0.05). Multivariate logistic regression analysis indicated that prolonged operation duration (OR=1.013, 95%CI:1.002-1.025, P=0.025), increased pleural thickness (OR=1.189, 95%CI:1.020-1.387, P=0.027), thoracotomy surgical method (OR=4.503, 95%CI:1.532-13.231, P=0.006), and increased postoperative drainage volume (OR=1.001, 95%CI:1.000-1.003, P=0.027) were risk factors for postoperative acute pain (P<0.05), while being male (OR=0.101, 95%CI:0.029-0.351, P<0.001) was a protective factor against acute postoperative pain. Conclusion Patients with stage Ⅲ tuberculous empyema exhibit a higher incidence of postoperative acute pain, which correlates with factors such as gender, surgical duration, pleural thickness, surgical approach, and postoperative drainage volume. Clinicians should prioritize acute pain management in female patients, those undergoing thoracotomy, those with pleural thickening, prolonged operative time, and increased postoperative drainage, while implementing early pain intervention strategies.

Key words: Ⅲ tuberculous empyema, Acute postoperative pain, Influencing factors