Sex-specific effects of surgical duration on peak pain after pediatric adenotonsillectomy.

backgroundAmong pediatric otolaryngologic surgeries, adenotonsillectomy is one of the most frequently performed. The interaction between surgical duration and patient factors in shaping peak postoperative pain has not been well defined. We evaluated whether this association differs by sex.

methodsWe conducted a prospective cohort study in children aged 3–12 years undergoing low-temperature plasma adenotonsillectomy. All patients followed a standardized as-needed (PRN) analgesic regimen. Pain was assessed using a visual analog scale (VAS) at six scheduled time points during the first 14 postoperative days. Peak postoperative pain was defined as the highest VAS score across these assessments. Multivariable linear regression was used to evaluate factors associated with peak pain. A sex × duration term was included, with adjustment for age and BMI.

resultsOf 279 children enrolled, 244 (95 males, 149 females) provided complete data for analysis. Baseline characteristics were similar between sexes. A significant interaction between sex and surgical duration was identified in the multivariable model (p = 0.041), despite non-significant main effects. Stratified analyses showed that longer surgical duration was associated with higher adjusted peak pain in females (p = 0.001) but not in males (p = 0.927). A dose–response pattern was observed in females (p for trend = 0.002), with higher adjusted peak pain in procedures lasting more than 22 min.

conclusionSurgical duration influenced peak postoperative pain differently in males and females. Female children had higher adjusted peak pain with longer operative times, whereas no such pattern was seen in males. When operative time is prolonged, a routine as-needed (PRN) analgesia regimen may warrant closer monitoring for female patients.