Using peri-operative patient- and parent-reported experience and outcome measures to identify paediatric postsurgical recovery trajectories: an observational cohort study.

Abstract

Identifying postoperative pain trajectories and pre-operative risk factors may support preventative measures and enhance pain management. We aimed to determine the feasibility of gathering peri-operative data from families of children, describe their recovery trajectories and identify risk factors for high postsurgical pain. Peri-operative data were collected from patients aged 0-18 y. A pre-operative survey collected demographic, physical, psychosocial and family factors. Postoperative outcome surveys were sent at several postoperative time points. Growth mixture modelling established discrete trajectories for average and worst pain intensity. Relationships between pre-operative factors and postoperative pain trajectories were explored using multinomial logistic regression. The survey was completed for 444 patients. Median (IQR [range]) age was 9 (4-14 [0-18]) y, 34.5% were female. Follow-up retention was > 65% up to postoperative day 30 for patients < 5 y and up to postoperative day 15 for patients > 5 y. Recovery trajectories revealed non-zero pain scores up to postoperative day 90. Pre-operative risk factors for a high average pain trajectory included: age 13-18 y (OR 5.9, 95%CI 3.1-11.5, p < 0.001); female sex (OR 2.1, 95%CI 1.3-3.3, p = 0.002); orthopaedic surgery (OR 4.1, 95%CI 1.7-10.4, p = 0.002); anxiety (OR 2.0, 95%CI 1.1-3.5, p = 0.017); depression (OR 2.1, 95%CI 1.2-3.6, p = 0.007); previous emotional trauma (OR 2.5, 95%CI 1.5-4.3, p = 0.001); analgesic use > 7 days before surgery (OR 3.4, 95%CI 1.8-6.8, p < 0.001); and parental chronic pain (OR 4.1, 95%CI 1.6-12.7, p = 0.007). Collecting longitudinal postoperative recovery data from adolescents and parents of children is feasible and may improve the understanding of pain and recovery trajectories. This study identifies patient, parental and surgical factors associated with a higher likelihood of a high pain trajectory.