Incidence and Risk Factors for Acute and Persistent Postoperative Pediatric Pain: The 4P Prospective Observational Multicenter Study.

Background

Large prospective studies on the prevalence of acute and persistent pain in children are limited, and risk factors associated with post-surgical pain in children remain unclear.

Objective

To examine the incidence of pediatric acute (APOP) and persistent postoperative pain (PPOP) and to determine whether factors such as age, sex, preoperative anxiety/sleep disturbance, preoperative pain and parental stress are associated with increased risk.

Design

Prospective observational multicenter study.

Setting

Hospitals performing pediatric surgery in southern Sweden. Patients: 601 children aged 1-17 years planned for one of the European Society of Pediatric Anesthesia (ESPA) pre-defined surgical procedures: inguinal hernia, circumcision/hypospadias/retentio testis, adenoidectomy/tonsillectomy/tonsillotomy, appendectomy and orthopedic acute fracture surgery. Main outcome measures: Postoperative pain in PACU after 24 h and 3, 6 and 12 months, level and description of the pain and effect on the child.

Results

The incidence of APOP in the postoperative care unit was 0-27%, increasing to 13-58% after 24 h depending on surgery type. The incidences of PPOP were 4-24%, 4-30%, and 0-19% at 3, 6, and 12 months, respectively, depending on surgery type. Older age was a risk factor for APOPPACU (OR 1.2, p < 0.001) and APOP24h (OR 1.3, p < 0.001), whereas female sex was a risk factor only for PPOP6months (OR 2.1, p = 0.028). Self-reported parental stress was a significant risk factor for postoperative pain at all follow-ups, exhibiting increasing influence (APOP24h OR 1.2, p = 0.001; 3months OR 1.5, p < 0.001; 6months OR 1.3, p < 0.001; 12months OR 1.5, p < 0.001). Preoperative anxiety/sleep disturbance only affected APOPPACU (OR 2.0, p = 0.008), whereas preoperative pain was not a risk factor.

Conclusions

The incidences of APOP and PPOP were lower than in previous studies. Possible risk factors for acute pain include older age and preoperative anxiety/sleep disturbance. Only self-reported parental stress was a consistent risk factor for persistent pain.