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Association of Posttraumatic Growth and Analgesic Use in Postoperative Patients. BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.