Purpose <p>This study aimed to investigate whether preoperative anxiety levels influence the incidence and severity of chronic postoperative pain in patients undergoing inguinal hernia repair.</p> Methods <p>A prospective observational study was conducted in 75 adult patients scheduled for elective inguinal hernia repair under general anesthesia. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Pain intensity and characteristics were evaluated with the Numeric Rating Scale (NRS) at 24&#xa0;h, 1 month, 3 months, and 6 months postoperatively. Chronic postoperative pain was defined as pain persisting for ≥ 3 months. Statistical analyses included Spearman correlation and logistic regression to identify predictors of chronic pain. The primary outcome was the incidence of chronic postoperative pain (CPSP), defined as NRS ≥ 1 at ≥ 3 months. Effect sizes are reported with 95% confidence intervals.</p> Results <p>Of 75 enrolled patients, 64 completed the 6-month follow-up. Chronic postoperative pain was reported in 46.9% at 3 months and 39.1% at 6 months, with 25% experiencing moderate-to-severe pain (NRS ≥ 4) at 6 months. Persistent pain at 6 months was predominantly neuropathic in nature. Higher preoperative STAI-State and STAI-Trait scores were significantly correlated with pain intensity at 1, 3, and 6 months (<i>p</i> &lt; 0.001). Multivariate logistic regression identified the STAI-State score as an independent predictor of chronic pain, with each 1-point increase raising the odds by 40% (OR 1.40, 95% CI 1.20–1.64).</p> Conclusion <p>Preoperative anxiety was associated with chronic postoperative pain after inguinal hernia repair. These findings highlight an association and underscore the need for larger multicenter studies with longer follow-up.</p> Trial registration <p>Not applicable.</p>