Risk and Resilience in Recovery Following Surgery for Adolescent Idiopathic Scoliosis

Abstract

The majority of children who undergo major surgery for scoliosis tend to recover well, but there is variability in recovery outcomes with retrospective studies demonstrating that some patients report impairments in certain aspects of their quality of life as well as pain that can impact functioning. A few prospective studies of pediatric postsurgical recovery have been conducted more recently, but most of what is known about postsurgical pain and functioning comes from the adult literature. Additionally, most studies to date are focused on identifying risk factors for the development of chronic postsurgical pain with little attention paid to protective factors related to postsurgical pain and functioning. This dissertation sought to further our understanding of pediatric postsurgical pain and recovery following major surgery and to examine recovery from a resilience perspective. Paper one used a prospective longitudinal cohort design to identify postsurgical pain trajectories over the first postsurgical year in adolescents (n = 202) who underwent surgery for scoliosis. Differences in functional outcomes at one year were examined across identified trajectories and baseline parent and child predictors of trajectory membership were examined. Three distinct trajectories were identified. The majority of adolescents followed a trajectory with low pain and good functional outcomes. The other two trajectories were characterized by high immediate postsurgical pain but only one was characterized by pain that persisted over the first year. Patients in the latter trajectory reported worse functional outcomes at one year and membership in the trajectory was predicted by greater baseline pain and child anxiety. Paper two was a topical review that provided a rationale for identifying and examining protective factors in pediatric postsurgical recovery, reviewed the pediatric chronic pain and adult postsurgical literature to identify potentially relevant protective factors at the individual, parent and peer levels and provided specific recommendations for future research. Paper three examined the role of optimism, a protective factor, in pediatric postsurgical recovery outcomes at two time points in the postsurgical recovery period using a sample of adolescents (n = 151) who had undergone surgery for scoliosis. Optimism was predictive of quality of life at one year after surgery and was found to moderate the relation between pain and functional disability one year after surgery. Optimism was not related to either quality of life or functional disability during a more acute phase of recovery. Taken together, the findings of this dissertation demonstrate that a small subset of adolescents are at risk of developing chronic postsurgical pain and poor functioning but that the majority recover well from major spinal surgery and that optimism may be one of several protective factors that could be used to promote good postsurgical outcomes.