The Adolescent Surgery Experience (ASE) prospective cohort study: Postoperative pain trajectory, opioid use and...

Between 3-5% of adolescents develop new persistent opioid use after surgery. Little is known about their recovery experience, including pain trajectory, pain treatment and prolonged opioid use.

This prospective cohort study enrolled adolescents between June 2022 to May 2023 prior to undergoing select procedures associated with mild, moderate or severe postoperative pain ('major procedures'). We collected data using text-message surveys at baseline, daily for the first two postoperative weeks and monthly for five months; baseline data are reported separately. The primary outcome was persistent pain at Month 3. Secondary outcomes included satisfaction with recovery, time in days to resolution of acute, severe pain, and prolonged opioid use (>2 weeks). We utilized generalized linear models (GLMs) to model resolution of surgical site pain over time.

The cohort included 340 adolescents with a median age of 15 years (IQR 13.5-17) who provided outcome data at Month 3, including 141 undergoing major procedures. Within this group, persistent surgical site pain was present at Month 3 among 57.9% (n=81), while only 9.2% (n=13) were 'unhappy' or 'very unhappy' with their recovery. Severe pain (NRS 7-10) resolved within 3 days (IQR 1-6) after surgery. However, prolonged opioid use in Weeks 3 and 4 was present among 39.6% (n=44). The odds of persistent surgical site pain declined by 25% (OR 0.75, 95% CI 0.67-0.83) each month, and female sex was the only significant individual predictor (OR 1.95, 95% CI 1.11-3.42 p=0.02). Trends were similar, but decreased in magnitude, among those recovering from mild and moderate pain procedures.

After major surgery, a high proportion of adolescents endorsed persistent pain in Month 3 despite relative recovery satisfaction. In addition, an unanticipated number used opioids after resolution of severe pain for which opioids may be indicated.