356PREOPERATIVE ANXIETY, CHRONIC PAIN, AND SURGICAL MAGNITUDE AS PREDICTORS OF SEVERE POSTOPERATIVE PAIN A PROSPECTIVE COHORT STUDY Background: Poorly controlled postoperative pain remains a major clinical concern because it delays recovery, prolongs hospital stay, increases postoperative complications, reduces patient satisfaction, and may contribute to the development of persistent chronic pain. Early identification of patients at increased risk of severe postoperative pain may facilitate individualized analgesic strategies and improve perioperative outcomes. Objective: To identify patient-, surgical-, and perioperative-related factors associated with severe postoperative pain following major surgical procedures. Methods: A prospective cohort study was conducted among 200 adult patients undergoing major surgical interventions. Postoperative pain intensity was assessed using the Numerical Rating Scale (NRS) during the first 24–48 hours after surgery. Severe postoperative pain was defined as an NRS score of 7 or greater. Demographic variables, preoperative characteristics, psychological factors, chronic pain history, and intraoperative details were collected and analyzed. Associations between potential predictors and severe postoperative pain were initially evaluated using chi-square tests, followed by multivariable logistic regression analysis to determine independent predictors and adjusted odds ratios (aORs). Results: Severe postoperative pain was observed in 60 patients, representing 30% of the study population. Multivariable analysis demonstrated that high preoperative anxiety was the strongest independent predictor of severe pain (aOR ? 2.6), followed by a history of chronic pain before surgery (aOR ? 2.3) and undergoing major or open surgical procedures (aOR ? 2.1). Younger age and female sex were also significantly associated with an increased likelihood of severe postoperative pain. Conclusion: Severe postoperative pain was common among patients undergoing major surgery. Preoperative anxiety, chronic pain, surgical magnitude, younger age, and female sex were significant predictors, supporting the implementation of risk stratification and multimodal, anxiety-focused preventive analgesic approaches to optimize postoperative pain management and recovery outcomes-Research922019Postoperative pain; Numerical rating scale; Preoperative anxiety; Acute pain; Opioid; Risk factors.Dr. Sai Suraj K.N,Dr. Ramaiah BAssistant Professor, Department of Anaesthesiology, Sri Lakshmi Narayana Institute of Medical Sciences & Hospital, Osudu, Puducherry – 605502, India.,Assistant Professor, Department of General Medicine, Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry – 605107, India