Acute and chronic pain delay recovery and impair outcomes after major pediatric surgery. Understanding unique risk factors for acute and chronic pain is critical to developing effective treatments for youth at risk. We aimed to identify adolescent and family psychosocial predictors of acute and chronic postsurgical pain following major surgery in adolescents. Participants included 119 youth age 10-18 years (M=14.9;78.2% white) undergoing major musculoskeletal surgery and their parents. Participants completed pre-surgery baseline questionnaires, with youth reporting on baseline pain, anxiety, depression, insomnia and sleep quality, and parents reporting on parental catastrophizing and family functioning. At baseline, 2-weeks, and 4-months post-surgery, youth completed 7-days of daily pain diaries and reported on health-related quality of life. Sequential logistic regression models examined pre-surgery predictors of acute and chronic postsurgical pain, defined as significant pain with impairment in health-related quality of life. Acute pain was experienced by 27.2% of youth at 2-weeks, while 19.8% of youth met criteria for chronic pain at 4-months. Baseline pain predicted acute pain (OR=1.96; 95%CI=1.32-2.90), while depressive symptoms (OR=1.22; 95%CI=1.01-1.47) and sleep quality (OR=0.26; 95%CI=0.08-0.83) predicted chronic pain. Tailored interventions need to be developed and incorporated into perioperative care to address risk factors for acute and chronic pain. Perspective: Longitudinal results demonstrate adolescents’ pre-surgery pain severity predicts acute postsurgical pain, while depressive symptoms and poor sleep quality predict chronic postsurgical pain. Tailored interventions should address separate risk factors for acute and chronic pain after adolescent surgery.Copyright © 2020. Published by Elsevier Inc.