Mapping the current state of pediatric surgical pain care across Canada and assessing readiness for change

Abstract

Background Preventing pediatric chronic postsurgical pain is a patient, parent/caregiver, healthcare professional, and policymaker priority. Poorly managed presurgical and acute postsurgical pain are established risk factors for pediatric chronic postsurgical pain. Effective perioperative pain management is essential to prevent the transition from acute to chronic pain after surgery. Aims To identify current pediatric surgical pain management practices and assess health system readiness for change at healthcare institutions conducting pediatric surgery in Canada. Methods An online survey was completed by 85 multidisciplinary healthcare professionals (nurses, surgeons, anesthesiologists, allied health) from 20 health institutions in Canada regarding institutional pre- and post-surgical pediatric pain care, specialty pain services, and Organizational Readiness for Implementing Change (ORIC). Results Of all specialty pain services, acute and chronic/complex pain services were most common, primarily with physician and nursing involvement. Alignment to recommended practices for pediatric pre- and post-surgical pain care varied (38.1-79.8% reported ‘yes, for every child’) with tertiary/quaternary children’s hospitals reporting less alignment than other institutions (community/regional or rehabilitation hospitals, community treatment centers). No significant differences were reported between healthcare institutions serving pediatric populations only versus those also serving adults. Healthcare professional experience/practice was the most reported strength in pediatric surgical pain care with inconsistent standard of care the most common gap. Participants ‘somewhat agreed’ their institutions were committed and capable of change in pediatric surgical pain care. Conclusions There is a continued need to improve pediatric pain care during the perioperative period at Canadian healthcare institutions to effectively prevent the development of pediatric postsurgical pain.

Keywords

• children
• surgery
• pediatric pain
• postsurgical pain
• health systems
• care delivery