{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T06:18:19Z","timestamp":1788157099261,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T00:00:00Z","timestamp":1787875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Region Halland, Southern Healthcare Region, Sweden, Sparbanken Varberg"},{"id":[{"id":"https:\/\/ror.org\/01q8csw59","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Stig and Ragna Gorthon Foundation, Helsingborg"},{"id":[{"id":"https:\/\/ror.org\/0192sgm30","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Pers. Med.","JPM"],"abstract":"<jats:p>Background: Large prospective studies on the prevalence of acute and persistent pain in children are limited, and risk factors associated with post-surgical pain in children remain unclear. Objective: To examine the incidence of pediatric acute (APOP) and persistent postoperative pain (PPOP) and to determine whether factors such as age, sex, preoperative anxiety\/sleep disturbance, preoperative pain and parental stress are associated with increased risk. Design: Prospective observational multicenter study. Setting: Hospitals performing pediatric surgery in southern Sweden. Patients: 601 children aged 1\u201317 years planned for one of the European Society of Pediatric Anesthesia (ESPA) pre-defined surgical procedures: inguinal hernia, circumcision\/hypospadias\/retentio testis, adenoidectomy\/tonsillectomy\/tonsillotomy, appendectomy and orthopedic acute fracture surgery. Main outcome measures: Postoperative pain in PACU after 24 h and 3, 6 and 12 months, level and description of the pain and effect on the child. Results: The incidence of APOP in the postoperative care unit was 0\u201327%, increasing to 13\u201358% after 24 h depending on surgery type. The incidences of PPOP were 4\u201324%, 4\u201330%, and 0\u201319% at 3, 6, and 12 months, respectively, depending on surgery type. Older age was a risk factor for APOPPACU (OR 1.2, p &lt; 0.001) and APOP24h (OR 1.3, p &lt; 0.001), whereas female sex was a risk factor only for PPOP6months (OR 2.1, p = 0.028). Self-reported parental stress was a significant risk factor for postoperative pain at all follow-ups, exhibiting increasing influence (APOP24h OR 1.2, p = 0.001; 3months OR 1.5, p &lt; 0.001; 6months OR 1.3, p &lt; 0.001; 12months OR 1.5, p &lt; 0.001). Preoperative anxiety\/sleep disturbance only affected APOPPACU (OR 2.0, p = 0.008), whereas preoperative pain was not a risk factor. Conclusions: The incidences of APOP and PPOP were lower than in previous studies. Possible risk factors for acute pain include older age and preoperative anxiety\/sleep disturbance. Only self-reported parental stress was a consistent risk factor for persistent pain.<\/jats:p>","DOI":"10.3390\/jpm16090450","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T05:55:56Z","timestamp":1788155756000},"page":"450","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and Risk Factors for Acute and Persistent Postoperative Pediatric Pain: The 4P Prospective Observational Multicenter Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1863-5584","authenticated-orcid":false,"given":"Johanna","family":"Broman","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Helsingborg Lasarett, 25187 Helsingborg, Sweden"},{"name":"Department of Clinical Sciences Helsingborg, Lund University, 25225 Helsingborg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6013-126X","authenticated-orcid":false,"given":"Niklas","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Helsingborg Lasarett, 25187 Helsingborg, Sweden"},{"name":"Department of Clinical Sciences Helsingborg, Lund University, 25225 Helsingborg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9000-849X","authenticated-orcid":false,"given":"Anna K. M.","family":"Persson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Halland Hospital Halmstad, 30233 Halmstad, Sweden"},{"name":"Department of Clinical Sciences Malm\u00f6, Lund University, 20213 Malm\u00f6, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"software","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"934","DOI":"10.1097\/ALN.0b013e31828866b3","article-title":"Pain Intensity on the First Day after SurgeryA Prospective Cohort Study Comparing 179 Surgical Procedures","volume":"118","author":"Gerbershagen","year":"2013","journal-title":"Anesthesiology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.bjae.2021.11.008","article-title":"Chronic post-surgical pain\u2014Update on incidence, risk factors and preventive treatment options","volume":"22","author":"Rosenberger","year":"2022","journal-title":"BJA Educ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1016\/j.jpain.2017.03.007","article-title":"Prevalence and Predictors of Chronic Postsurgical Pain in Children: A Systematic Review and Meta-Analysis","volume":"18","author":"Rabbitts","year":"2017","journal-title":"J. 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