Preoperative guidance and an adolescent’s surgical recovery experience: A qualitative study

BACKGROUND: Adolescents are at increased risk of persistent postsurgical opioid use. Qualitative data may provide insight on protective experiences and guidance. STUDY DESIGN: Adolescents aged 11-21 years who were enrolled in a larger longitudinal survey study participated in semi-structured interviews one and three months after surgery between September 2022 and March 2023. Experiences were examined among adolescents who used opioids in postoperative weeks 3 and 4, after severe pain resolved. RESULTS: Fifty interviews with 46 adolescents undergoing common procedures associated with severe pain and/or persistent opioid use revealed that preoperative clinic conversations set an important framework for recovery. Positive experiences included normalizing anxiety, awareness of physical changes signifying recovery, including resolution of severe pain and subsequent opioid cessation, and effective non-opioid and non-pharmacologic pain treatment options, including ice and stretching. Patients with prolonged opioid use, whose caregivers often directed pain management, described more profound fears, struggles with seeking out information, difficulties actively engaging in recovery, and the use of opioids and sleep to avert pain. CONCLUSION: The preoperative visit and recovery framework provided by the surgical team played an important role in guiding the recovery experience. Factors that may offer protection against prolonged opioid use include realistic descriptions of the recovery process with common milestones, encouraging preparation and engagement in the work of recovery, and educating on the role of opioid, non-opioid, and non-pharmacologic pain management options, including when to stop using opioids.