• Brittany N Rosenbloom, Simona Denise Frederiksen, Vienna Wang, Christine S Park, Grace Gordon, Gurpreet Brar, Nivez Rasic, Jennifer N Stinson, Kathryn A Birnie, and Jennifer A Rabbitts.
• Toronto Academic Pain Medicine Institute, Women's College Hospital, Toronto, Ontario, Canada brittany.rosenbloom@wchospital.ca.
• Reg Anesth Pain Med. 2025 Feb 5; 50 (2): 144152144-152.

BackgroundApproximately 28% of children and adolescents undergoing major surgery develop chronic postsurgical pain (CPSP; pain persisting>3 months). A previous review attempted to investigate biopsychosocial prognostic factors for pediatric CPSP; however, due to lack of data, no meta-analytic techniques were employed. Since that review, numerous studies have investigated risk/protective factors that fall within an Interpersonal Fear Avoidance Model for CPSP, thus warranting a reinvestigation of prognostic factors.ObjectiveThis systematic review and meta-analysis aimed to examine prognostic factors, measurement tools applied, and their effect on the development of CPSP.Evidence ReviewProspective, observational studies examining prognostic factors of pediatric CPSP using validated self-report measures were included. 4884 unique publications were screened and 15 met inclusion criteria.FindingsThe pooled effect size for the association between presurgical child pain intensity and the presence of child CPSP was significant, OR=0.540 (95% CI=0.184 to 0.894). Child anxiety, child pain-related anxiety, and parent pain catastrophizing were not significant prognostic factors for child CPSP. Using Grading of Recommendations, Assessment, Development, and Evaluation, the certainty in prognostic estimates was moderate. Risk of bias using Quality in Prognostic Study tool ranged from low to moderate.ConclusionsPresurgical pain was the only presurgical risk factor at the meta-analytic level that significantly predicted pediatric CPSP, highlighting the importance of prioritizing pain management throughout the perioperative experience, starting before surgery. Depressive symptoms and sleep disturbance were the two potential risk/protective factors that were unable to be assessed due to insufficient data or use of an unvalidated measure indicating a critical need for future research.Prospero Registration NumberCRD42022306340.© American Society of Regional Anesthesia & Pain Medicine 2025. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ Group.

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