O3267: Parent and Child Anxiety do not Predict Postoperative Pain following Surgical Treatment of Pediatric Supracondylar Humerus Fractures

Background: Child and caregiver anxiety has been shown to predict increased pain following elective procedures. Limited data exists on the relationship between anxiety and postoperative pain following traumatic injuries. This study aims to characterize the baseline anxiety of families presenting for surgical treatment of supracondylar humerus fractures and determine if anxiety influences postoperative pain.

Methods: Children aged 3-12 years old undergoing closed reduction and percutaneous pinning (CRPP) for an isolated supracondylar humerus fracture were recruited for a prospective multicenter comparative cohort study on postoperative pain and opioid use. At enrollment, the Generalized Anxiety Disorder 7-item questionnaire (GAD-7) and the Spence Children’s Anxiety Scales (SCAS) were used to assess caregivers’ and children’s baseline anxiety, respectively. Caregiver and child anxiety were categorized as normal or elevated according to validated scoring methodologies. Caregivers received text-message questionnaires to report their child’s daily pain on the Wong-Baker FACES scale on postoperative days (POD) 1-7, 10, 14, and 21. Descriptive and bivariate analyses were performed.

Results: Of the 157 caregiver-child dyads recruited, 134 caregivers and 138 children had completed anxiety questionnaires. Elevated anxiety was found in 10.4% of caregivers and 19.6% of children. Older and female children were significantly more likely to have elevated anxiety compared to younger and male children. Child race, ethnicity, body mass index, and Gartland fracture type were not related to parent or child anxiety. Elevated caregiver anxiety was significantly related to decreased pain reported for the child on POD2 (1.9 vs 3.5 out of 10, p=0.01). Child anxiety was not correlated to increased postoperative pain. Neither caregiver nor child anxiety predicted increased mean pain over the entire 21-day recovery period. Caregivers with higher anxiety tended to give more opioids (1.1 vs 0.9; p< 0.01) and overall total medications to their children compared to lower-anxiety caregivers, though this difference was not statistically significant. Hospital length of stay was not significantly different when caregivers or children had elevated anxiety.

Conclusion: Child anxiety does not influence postoperative pain following CRPP for supracondylar humerus fractures. Around 1/5 of children presenting for CRPP for supracondylar humerus fractures have elevated baseline anxiety. Elevated anxiety is more common among older and female children. Neither caregiver nor child anxiety influence hospital length of stay or postoperative pain scores. Caregiver anxiety may impact opioid and non-opioid pain medication intake. Parents should be routinely counseled on appropriate post-operative analgesia strategies to minimize the impact of underlying anxiety.