Authors of a study published in the Journal of Pain found that approximately 10% of adolescents who underwent common surgical procedures developed chronic pain.
Investigators from Stanford University sourced data for this study from the Optum® Clinformatics Data Mart Database. Patients (n=424,590) aged 21 years and younger who underwent 20 of the most common surgeries between 2002 and 2017 were evaluated for a diagnosis of new-onset chronic pain 90 to 365 days following surgery. A group of randomly sampled patients (n=1,565,553) who had a diagnosis of nonsurgical pain were used as the comparator group.
The patients were stratified into age groups: 0 to 1, 2 to 5, 6 to 11, 12 to 18, and 19 to 21 years. Tonsillectomy and/or adenoidectomy was the most common surgery (1.6%) among patients aged 0 to 1 year, tympanoplasty (4.0%) was the most common surgery among patients aged 2 to 5 years, appendectomy was the most common surgery (6.5%) among patients aged 6 to 11 years, cholecystectomy and common ductal exploration (15.6%) was the most common surgery among patients aged 12 to 18 years, and aspiration after delivery and abortion (14.3%) were the most common surgical procedures among patients aged 19 to 21 years.
Overall, the prevalence of chronic pain was higher among the surgical cohort than the nonsurgical cohort for patients aged 0 to 1 year (1.1% vs 0.59%; P <.001), 2 to 5 years (3.0% vs 2.0%; P <.001), 6 to 11 years (5.6% vs 3.8%; P <.001), 12 to 18 years (10.1% vs 6.4%; P <.001), and 19 to 21 years (9.9% vs 6.5%; P <.001), respectively.
The rate of surgery-associated chronic pain was 5.3% overall, or 3.0% in infancy and childhood (0-11 years of age) and 10.0% in adolescence (12-21 years of age).
Risk for chronic pain among the surgical cohort was associated with all surgeries in general for all age groups and 3 specific procedures for patients aged 0 to 1 year, 4 specific procedures for patients aged 2 to 5 years, 8 specific procedures for patients aged 6 to 11 years, 6 specific procedures for patients aged 12 to 18 years, and 5 specific procedures for patients aged 19 to 21 years. Common procedures associated with increased risk for chronic pain included tonsillectomy and/or adenoidectomy, dental procedures, myringotomy, excision of skin lesion, and female organ procedures.
The common patient features associated with risk for postsurgical chronic pain included age, gender, and perioperative opioid prescriptions.
This study may have been limited by the group differences observed between the surgical and nonsurgical cohorts.
These data indicate that among pediatric patients and young adults, approximately 5% of patients overall and 10% of adolescents undergoing common surgical procedures developed chronic pain. The study authors conclude, “Given the association of [chronic pain] with adverse outcomes, further investigation is warranted to identify high risk patients and optimal implementation of prevention strategies.”
Thapa I, De Souza E, Ward A, Bambos N, Anderson TA. Association of common pediatric surgeries with new onset chronic pain in patients 0-21 years of age in the United States. J Pain. Published online October 7, 2022. doi:10.1016/j.jpain.2022.09.015