title: The prevalence of pain at home and its consequences in children following two types of short stay surgery: a multicenter observational cohort study.
abstract: BACKGROUND
  The potential for pain at home in children following day case surgery has long been recognized. Pain has also been associated with behavioral disturbances and sleep disruption in children following surgery and may also impact negatively on recovery, parental and patient satisfaction, family life, healthcare use, and have an economic cost.
  
  
  OBJECTIVE
  To investigate the prevalence of pain at home, and its consequences, in children following two types of short stay surgery across eight pediatric centers in the UK in an observational cohort study. Reporting of the study was done in adherence with STROBE guidelines.
  
  
  METHODS
  Two hundred and forty-one children undergoing either Tonsillectomy with or without Adenoidectomy (T's ± A's) or Orchidopexy surgery (either by Open or Laparoscopic) were recruited. Data collection was via three structured telephone interviews [Day (D) 2, 7 and 14] conducted from a clinical research facility. The normal clinical practices of the centers involved in the study were not altered in any way. Outcomes studied were (i) Pain incidence and severity; (ii) Associated consequences-incidence of psychological disturbances, unplanned use of healthcare services, and social/economic cost to families; and (iii) Comparative pain and associated outcomes for two types of surgery (T's ± A's vs Orchidopexy).
  
  
  RESULTS
  The incidence of pain following both operative models was high though it differed between the two groups. In the T's ± A's group, the incidence of pain was high throughout the study period (D2 90.1%, D3-7 88.1%, D8-14 61.8%). The Orchidopexy group demonstrated a similar pattern, though with decreased rates (D2 70.4%, D3-7 34.7%, D8-14 17.1%). Both groups showed similar patterns for the rates of behavioral disturbances (T's & A's: D2 76%, D3-7 73%, D8-14 30% and Orchidopexy: D2 37%, D3-7 20%, D8-14 10%). Seventy percent of the families reported unplanned healthcare use with pain the primary reason in 79% of these.
  
  
  CONCLUSIONS
  The prevalence of pain at home, and its potential associated consequences, is high following short stay surgery in children in the UK. In both groups, high incidences were seen for longer periods than is commonly perceived. These findings were consistent between the centers involved suggesting that this is a significant national healthcare issue with potential short- and long-term consequences for the child, their family, and health services.
authors.affiliation: Department of Anaesthesia, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Glyn
authors.initials: G
authors.lastname: Williams
authors.affiliation: Department of Anaesthesia, Royal Hospital for Sick Children, Glasgow, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Bell
authors.affiliation: Surgical Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Justin
authors.initials: J
authors.lastname: Buys
authors.affiliation: Department of Anaesthesia, Birmingham Children's Hospital, Birmingham, UK.
authors.forename: Tony
authors.initials: T
authors.lastname: Moriarty
authors.affiliation: Department of Anaesthesia, Royal National Throat Nose & Ear Hospital, University College Hospital, London, UK.
authors.forename: Anil
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Anaesthesia, St Georges Healthcare NHS Trust, London, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Sunderland
authors.affiliation: Department of Anaesthesia, Sheffield Children's Hospital, Sheffield, UK.
authors.forename: Liz
authors.initials: L
authors.lastname: Shepherd
authors.affiliation: Department of Anaesthesia, Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Brooks
authors.affiliation: Department of Anaesthesia, University College Hospital London, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Polhill
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects; D000293:Adolescent; D000556:Ambulatory Surgical Procedures; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D056126:Orchiopexy / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000191:economics / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D014068:Tonsillectomy / Q000009:adverse effects; D006113:United Kingdom / Q000453:epidemiology
keywords: acute pain; orchidopexy; outpatient; pediatric; postoperative; tonsillectomy