Background Pectus excavatum and pectus carinatum are the most common chest wall deformities. Although minimally invasive correction (minimally invasive repair of pectus, MIRP) has become common practice, it remains associated with severe postoperative pain. Preoperative psychosocial factors such as anxiety and low self-esteem can increase postsurgical pain. Early detection of psychological symptoms, effective biopsychosocial perioperative management of patients, and prevention of pain chronification using an enhanced recovery pathway (ERP) may improve outcomes. However, the incidence of the latter is poorly described in adolescents undergoing MIRP. Objective The objective of our study was to evaluate the implementation of an ERP containing early recovery goals and to assess persistent postsurgical pain 3 months postoperatively in pediatric patients undergoing MIRP. The ERP consists of a Web-based platform containing psychological screening questionnaires and extensive telemonitoring for follow-up of patients at home. Methods A population-based cohort study was conducted with prospectively collected data from patients undergoing pectus surgery between June 2017 and December 2017. An ERP was initiated preoperatively; it included patient education, electronic health-based psychological screening, multimodal pre-emptive analgesia, nausea prophylaxis as well as early Foley catheter removal and respiratory exercises. After hospital discharge, patients were followed up to 10 weeks using a Web-based diary evaluating pain and sleep quality, while their rehabilitation progress was monitored via Bluetooth-connected telemonitoring devices. Results We enrolled 29 adolescents using the developed ERP. Pre-emptive multimodal analgesia pain rating scores were low at hospital admission. Optimal epidural placement, defined by T8-9 or T9-10, occurred in 90% (26/29) of the participants; thus, no motor block or Horner syndrome occurred. Mean bladder catheterization duration was 3.41 (SD 1.50) days in ERP patients. Numeric rating scale (NRS) scores for pain and the incidence of nausea were low, contributing to a fluent rehabilitation. Mean NRS scores were 2.58 (SD 1.77) on postoperative day (POD) 1, 2.48 (SD 1.66) on POD 2, and 3.14 (SD 1.98) on POD 3 in ERP-treated patients. Telemonitoring at home was feasible in adolescents after hospital discharge despite adherence difficulties. Although the pain scores at the final interview were low (0.81 [SD 1.33]), 33% (9/27) long-term follow-up ERP patients still experienced frequent disturbing thoracic pain, requiring analgesic administration, school absenteeism, and multiple doctor (re)visits. Conclusions Allocating patients to the appropriate level of care preoperatively and immediately postoperatively may improve long-term outcome variables. Internet-based technologies and feasible, objective monitoring tools can help clinicians screen surgical patients for ri...

BackgroundPreoperative anxiety and depression are predominant risk factors for increased postoperative pain. Thoracic wall deformities in adolescents often cause low self-esteem, which contributes to psychological concerns. Several studies have suggested a relationship between preoperative mental health support and enhanced recovery after surgery.ObjectiveThis study investigated the validity of screening questionnaires concerning psychological trait and state characteristics via a patient-specific online platform.MethodsPatients scheduled for elective pectus surgery between June 2017 and August 2017 were invited to participate in clinical interviews and online self-report questionnaires. All patients were recruited in the Anesthesiology Department, Antwerp University Hospital, Belgium. This single-center observational cohort study was performed in accordance with the ethical standards of the International Council for Harmonisation–Good Clinical Practice guidelines and the Declaration of Helsinki after obtaining study approval by the Institutional Review Board and Ethics Committee of the Antwerp University Hospital, Belgium (study identifier: 17/08/082). An online preoperative psychological inventory was performed using the Rosenberg Self-Esteem Scale, Hospital Anxiety and Depression Scale, and State-Trait Anxiety Inventory. Postoperatively, pain intensity and interference were assessed using the Multidisciplinary Pain Inventory, Coping With Pain Questionnaire, and numeric pain rating scale assessment. Patient satisfaction of the Web-based platform was evaluated.ResultsA total of 21 adolescent patients used our Web-based psychological perioperative screening platform. Patients rated the mobile phone app, usability, and accessibility of the digital platform as good or excellent in 85% (17/20), 89% (17/19), and 95% (20/21) of the cases, respectively. A total of 89% (17/19) of the patients rated the effort of generating answers to the online questionnaires as low. The results from the completed questionnaires indicated a strong negative correlation between self-esteem and the anxiety trait (R=–0.72, P<.001) and overall anxiety characteristics (R=–0.49, P=.04). There was a positive correlation between depressive and anxiety characteristics and the anxiety trait (R=0.52, P=.03 and R=0.6, P=.02, respectively) measured by the online self-report questionnaires. Moreover, preoperative anxiety was positively correlated with postoperative pain interference (R=0.58, P=.02). Finally, there was a negative correlation between self-esteem and pain interference (R=–0.62, P=.01).Conclusions: Perioperative screening of psychological symptoms and trait characteristics with specific treatment, if necessary, could further improve postoperative pain and overall health status. Research on eHealth technology, even for psychological patient care, is rapidly increasing.Trial RegistrationClinicalTrials.gov NCT03100669; https://clinicaltrials.gov/ct2/show/NCT03100669 (Archived by WebCite at http://www.webcitation.org/6zPvHDhU5)

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BACKGROUND Pectus excavatum and pectus carinatum are the most common chest wall deformities. Although minimally invasive correction (MIPC) has become common practice, it remains associated with severe postoperative pain. Preoperative psychosocial factors such as anxiety and low self-esteem can increase postsurgical pain. Early detection of psychological symptoms, effective biopsychosocial perioperative management of patients and prevention of pain chronification using an enhanced recovery pathway (ERP) may improve outcomes. The incidence of the latter is poorly described in adolescents undergoing MIPC. OBJECTIVE To evaluate whether an ERP after surgery facilitated early recovery and to assess persistent postsurgical pain three months after surgery in pediatric patients undergoing MIPC using m-Health technology. METHODS A population-based cohort study was conducted with prospectively collected data from patients undergoing pectus surgery between June 2017 and December 2017. An ERP was initiated preoperatively and included patient education, eHealth-based psychological screening, multimodal preemptive analgesia, nausea prophylaxis as well as early Foley catheter removal and respiratory exercises. After hospital discharge, patients were assessed for up to ten weeks by evaluating pain and underwent rehabilitation using online diary and Bluetooth-connected telemonitoring devices. Retrospectively derived control patients in our hospital who were undergoing the same procedure without an ERP were matched by age (≤ 18 years). RESULTS Twenty-nine adolescents were enrolled using the developed ERP. Preemptive multimodal analgesia pain rating scores were low during hospital admission and were comparable between the groups. Optimal epidural placement occurred in 26 of the 29 participants (90%), hereby no motor block or Horner syndrome occurred. Bladder and epidural catheters were removed after 3.41 ± 1.50 and 5.76 ± 1.02 days, respectively. Low numeric pain rating scores (NRSs) and decreased incidence of nausea contributed to improved early rehabilitation. Telemonitoring at home was feasible in adolescents after hospital discharge despite adherence difficulties. Although pain scores at the final interview were low (0.81 ± 1.33), 9 out of 27 long-term follow up ERP patients (33%) still experienced frequent disturbing thoracic pain requiring analgesic administration, school absenteeism and multiple doctor (re)visits. CONCLUSIONS Allocating patients to the appropriate level of care preoperatively and immediately after surgery may improve long-term outcome variables. Using internet-based technologies and feasible, objective monitoring tools can help clinicians screen surgical patients for risk factors and initiate early treatment if necessary. Future research should focus on improving risk stratification and including a psychological assessment and evaluation of the effect of perioperative care pathways in children undergoing major surgery. CLINICALTRIAL ClinicalTrials.gov, NCT03100669, https://clinicaltrials.gov/ct2/show/NCT03100669

Background: Preoperative anxiety and depression are predominant risk factors for increased postoperative pain. Thoracic wall deformities in adolescents often cause low self-esteem, which contributes to psychological concerns. Several studies have suggested a relationship between preoperative mental health treatment and enhanced recovery after surgery. Objective: This study investigated the validity of screening questionnaires concerning psychological trait and state characteristics via a patient-specific online platform. Methods: Patients scheduled for elective pectus surgery between June 2017 and August 2017 were invited to participate in clinical interviews and online self-report questionnaires. All patients were recruited in the Anesthesiology Department, Antwerp University Hospital, Belgium. This single-center observational cohort study was performed in accordance with the ethical standards of Good Clinical Practice guidelines (ICH-GCP) and the Declaration of Helsinki after obtaining study approval by the Institutional Review Board and Ethics Committee of the Antwerp University Hospital, Belgium (study identifier: 17/08/082). Patients with a history of a psychiatric disease, chronic opioid use (more than three months) or revision surgery were excluded. A preoperative psychological inventory was performed using the Rosenberg self-esteem scale (RSES), Hospital Anxiety and Depression Scale (HADs) and State-Trait Anxiety Inventory (STAI). The results were postoperatively compared with pain intensity and interference using the Multidisciplinary Pain Inventory (MPI), Coping Pain Questionnaire (CPQ) and numeric pain rating scale assessment (NRS). Results: Of the 22 patients, 21 used our web-based psychological perioperative screening platform. A "success" was reported by 85% of the patients for the smartphone application, 89% for individual online platform usability and 95% for accessibility. A total of 89% of the patients rated the effort of generating answers to the online questionnaire as low. The results from the completed questionnaires indicated a strong negative correlation between self-esteem and the anxiety trait (R = -0.72, p < 0.01) and overall anxiety characteristics (R = -0.49, p = 0.04). There was a positive correlation between depressive and anxiety characteristics and the anxiety trait (R = 0.52, p = 0.03; R = 0.6, p = 0.02, respectively). Moreover, preoperative anxiety was positively correlated with postoperative pain interference (R = 0.58, p = 0.02). Finally, there was a negative correlation between self-esteem and pain interference (R = -0.62, p = 0.01). Conclusions: Perioperative screening of psychological symptoms and trait characteristics with specific treatment, if necessary, could further improve postoperative pain and overall health status. Research on E-health technology, even for psychological patient care, is rapidly increasing. Trial Registration: ClinicalTrials.gov NCT03100669