Persistent postoperative pediatric pain: a secondary analysis of the 4P prospective observational multicenter study

Few large studies have examined the prevalence and risk factors for persistent postoperative pain (PPOP) in children. Chronic pain in childhood can lead to significant personal suffering, including non-attendance at school and social isolation.

In a prospective observational multicenter study, we followed 601 children undergoing common pediatric surgeries. This secondary analysis aimed to describe the prevalence, characteristics, and exploratory risk factor associations of PPOP. The primary outcome was defined as recurrent pain (4 on an age-specific scale lasting for over three months after surgery. Persistent pain was further characterized regarding its impact on various activities and whether it was anatomically localized at the site of surgery.

Of the 601 children, 380 were available for follow-up at 3 and 6 months after surgery. The median age was 5 years, and 34% were female. Preoperative pain was reported by 41 children (11%), and 126 (33%) reported anxiety or sleep problems before surgery. Thirteen (3%) patients experienced PPOP (≥ 4) after either 3 (n = 9) or 6 months (n = 4). Ten attributed the pain to the surgical area, and in six children, the pain affected activity-levels. Five children used analgesics for their symptoms. Only one child experienced pain daily, and three children reported weekly pain. Applying a stricter definition from ICD-11 to our cohort resulted in an even lower PPOP prevalence: only three (0.8%) children experienced pain lasting more than 3 months, in whom the pain began or increased after surgery, was at a level ≥4, influenced activity-levels, and was located in the surgical area.

The prevalence of persistent postoperative pain after common pediatric surgeries was very low. As one of the few prospective multicenter studies in this field, these findings are noteworthy.