Presurgical Prognostic Factors for Chronic Postsurgical Pain Across Developmental Stages in Children, Adolescents, and Young Adults: A Systematic Review and Meta-Analysis

Background: Chronic postsurgical pain (CPSP) is a significant postoperative complication in children and adolescents, with long-term consequences that may extend into young adulthood. Although numerous presurgical factors have been proposed as potential predictors of CPSP, findings remain inconsistent, and no prior review has examined prognostic factors across a developmental window spanning childhood to young adulthood. The aim of this study was to identify presurgical prognostic factors for CPSP at 3, 6, 12, and 24 months after surgery in children, adolescents, and young adults. Methods: A systematic search of five electronic databases was conducted from inception to September 2025, following PRISMA guidelines. Eligible studies included participants aged 8– 22 years undergoing major surgery and reporting presurgical variables associated with CPSP. Two reviewers independently screened studies, extracted data, and assessed risk of bias. When possible, meta-analyses were performed using standardized mean differences or odds ratios. Results: Thirty articles were included. Although 44 presurgical factors were identified, only eight could be meta-analyzed due to inconsistent reporting, limiting the strength of quantitative conclusions. Baseline pain intensity was the most consistent predictor of CPSP, showing significant associations at 3 months and 6 months. Older age showed a small association with CPSP at 3 months but not thereafter. Sex, child pain catastrophizing, pain anxiety, anxiety sensitivity, parent pain catastrophizing, and parent pain anxiety were not significantly associated with CPSP. The evidence base was limited by heterogeneity, small samples, and underreporting of effect sizes. Conclusion: Across childhood, adolescence, and young adulthood, baseline presurgical pain intensity is the most robust predictor of CPSP. Psychological and sociodemographic factors showed limited prognostic value. However, quantitative conclusions are limited by inconsistent reporting across studies. Plain Language Summary: Why was the study done? Some children, adolescents, and young adults continue to experience pain long after surgery. This long-lasting pain is called chronic postsurgical pain and can affect daily life, school, work, and well-being. Most previous studies have focused on adults or only on short age ranges. Because of this, we still do not clearly understand which factors increase the risk of developing chronic pain after surgery across different stages of development, from childhood to young adulthood. Identifying these factors matters because some of them may be changed, helping to prevent long-term pain. What did the researchers do? By carefully selecting high-quality studies, the researchers explored which biological, psychological, and social factors were linked to a higher risk of long-term pain after surgery at different ages. What did the researchers find? The study found that several factors were linked to a higher risk of chronic postsurgical pain. These included older age within the pediatric-to-young-adult range, higher pain levels before or shortly after surgery, and psychological factors such as anxiety or fear related to pain. Similar factors appeared to play a role across ages, although their influence may change with development. What do these results mean? These findings show that chronic postsurgical pain develops through a combination of physical, psychological, and social factors. Importantly, some of these factors can be addressed early. This suggests that age-appropriate screening and tailored support before and after surgery may help reduce long-term pain in young people. Keywords: chronic postsurgical pain, prognostic factors, childhood, adolescence, young adulthood