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Trajectory of Pain, Functional Limitation, and Parental Coping Resources Following Pediatric Short-stay Surgery:
Tiina Jaaniste1,2, Jordan G Wood1,2, Anya Johnson3
1Department of Pain, Sydney Children's Hospital, Randwick.
Insights
Short-stay pediatric surgery places a significant burden on parents managing their child's pain and recovery. Parental pain-related catastrophizing is a key predictor of poorer outcomes, suggesting a need for pre-discharge screening.
Area of Science:
- Pediatric Surgery
- Pain Management
- Parental Coping
Background:
- Short-stay hospital admissions for pediatric surgery increase parental responsibility for post-discharge care.
- Effective management of pediatric post-surgical pain and functional recovery is crucial.
Purpose of the Study:
- To document the trajectory of child pain and parent-reported functional outcomes after short-stay pediatric surgery.
- To assess the trajectory of parental perceived personal coping resources.
- To determine if pre-discharge parental factors predict child pain intensity and functional recovery.
Main Methods:
- Children (4-14 years) undergoing tonsillectomy or appendectomy and their parents were studied.
- Parents completed pre-discharge questionnaires; daily assessments of pain and functioning were conducted for 10 days post-discharge via mobile devices.
- Data from 55 child-parent dyads were analyzed.
Main Results:
- Child pain intensity decreased to low levels by day 5 (appendectomy) or day 10 (tonsillectomy).
- Parental coping resources recovered more slowly after tonsillectomy than appendectomy.
- Parental pain-related catastrophizing significantly predicted child pain and functional recovery, even after controlling for time and coping resources.
Conclusions:
- Short-stay pediatric surgery imposes a substantial burden on parents managing their child's pain and functional impairment.
- Screening parents for pain-related catastrophizing before hospital discharge may help identify children at risk for poorer recovery.
- Targeted interventions for parental catastrophizing could improve pediatric post-surgical outcomes.
Objectives:
Although there are many benefits of short-stay hospital admissions for high volume, pediatric surgical procedures, this model of care places greater responsibility on parents for the management of children's pain. This study aimed to document the trajectory of child pain outcomes and a range of parent-reported functional outcomes following discharge from a short-stay surgical admission. Moreover, we aimed to document the trajectory of parental perceived personal coping resources. Second, we assessed whether parental dispositional factors, assessed before hospital discharge, predicted the child's pain intensity and parent-reported functional recovery.
Methods:
Participants included children (aged 4 to 14 y) admitted for a short-stay tonsillectomy or appendectomy, and their parents. Parents completed a questionnaire before discharge from hospital. Demographic and surgical information was recorded from medical records. Following discharge, daily assessments of pain and functioning were carried out over a 10-day period using iPods or mobile phones. Predischarge and postdischarge data were obtained for 55 child and parent dyads.
Results:
Pain intensity scores returned to low levels (2/10 or less) by day 5 for appendectomy and day 10 for tonsillectomy. Parents' perceived personal coping resources increased more slowly following tonsillectomy than appendectomy. Controlling for time since surgery and parental coping resources, parental pain-related catastrophizing was a significant predictor of child pain and functional recovery.
Discussion:
Short-stay surgery results in parents facing considerable burden in managing their child's pain and functional impairment over a 10-day period. The potential value of screening for parental pain-related catastrophizing before discharge from hospital warrants further consideration and may enable identification of children likely to experience poorer recovery.
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