The Adolescent Surgery Experience (ASE): a survey-based prospective cohort study to measure risk factors for persistent opioid use.

Background: Increasing data suggest adolescents have elevated risk of persistent postsurgical pain and opioid use, but their recovery experience remains poorly characterised. Methods: This prospective cohort study enrolled opioid-naive adolescents without chronic pain between June 2022 and May 2023 before undergoing procedures with anticipated mild, moderate, or severe postoperative pain. Participants completed eight surveys during recovery. We measured characteristics associated with persistent opioid use, including non-surgical site pain, difficulty sleeping, depression (Patient Health Questionnaire-9 [PHQ-9]), and anxiety (General Anxiety Disorder [GAD-7]) over 5 months after surgery. Results: Five hundred adolescents (median age: 15 yr (inter-quartile range 13-17 yr]) completed the baseline survey. Overall, 47.4% were female, 69.6% identified as White, 22.4% as Black/African American, and 10.8% as Hispanic/Latino. Overall, one in five (21.1%) reported depression, approximately two in five reported anxiety (37.4%), and one in six (16.6%) reported prior-year substance use. Among those undergoing procedures associated with severe pain, 93.4% received an outpatient opioid prescription (median 18 doses [inter-quartile range 12-25 doses]). At the end of the study, 16.7% (n=47) reported regular non-surgical site pain, 20.6% (n=58) had difficulty sleeping, and 15.7% and 15.3% had persistent depression and anxiety symptoms, respectively. Conclusion: A high proportion of adolescents endorsed preoperative anxiety, depression, and substance use, which, in combination with prescription opioids, are known risk factors for postoperative opioid use disorder. Over time, postoperative non-surgical site pain, difficulty sleeping, depression, and anxiety declined but remained common. Additional research is needed to understand the relationship between pre- and postoperative risk factors and adverse outcomes during surgical recovery. Clinical trial registration: NCT05482919.