A Trajectory Analysis of Pain Following Tonsillectomy
JOINT CORE/EBOH EPI Seminar Series Fall 2025
The Seminars in Epidemiology organized by the Department of Epidemiology, Biostatistics and Occupational Health at the 涩里番 School of Population and Global Health is a self-approved Group Learning Activity (Section 1) as defined by the maintenance of certification program of the Royal College of Physicians and Surgeons of Canada. Physicians requiring accreditation, please complete the Evaluation Form and send to admincoord.eboh [at] mcgill.ca.
Dr. Karen Brown
Professor of Medicine
Dept of Anesthesia, Div of Pediatric Anesthesia
Montreal Children's Hospital | 涩里番 Health Center
WHEN: Monday, November 24, 2025, from 3:30-4:30pm
WHERE: Hybrid | 2001 涩里番 College, Rm 1140 &
Onsite at 5252 boul. de Maisonneuve - 3rd floor, 3B Kitchen |
Note: Karen Brown will be presenting in-person at CORE
Abstract
Obstructive sleep-disordered breathing (oSDB) is pro-inflammatory and thus may modulate pain. We conducted a prospective cohort study of children (2-12y) undergoing adenotonsillectomy. EXPOSURE variable (severity of oSDB) = STBUR questionnaire score. OUTCOME variable(s) Parents鈥� Postoperative Pain Measure for 14 postoperative days (PODs). Results Complete PPPM data (2,480 scores) for 10 PODs were recorded from 124/245 (51%) patients. Imputed values were derived for 941 missing PPPM scores. Group-based trajectory models identified 3 pain trajectory groups. Children with higher mSTBUR scores were significantly less likely to be in the low or moderate pain trajectory groups. When compared with Trajectory1, children in Trajectory2 and Trajectory3 had respectively, 4-fold and 11-fold higher odds for unscheduled revisits to hospital.
Speaker Bio
Dr Brown graduated Medicine at the University of Toronto. In 1990 she was recruited to Montreal Children鈥檚 Hospital Department of Pediatric Anesthesia. Sleep apnea was emerging as a major indication for tonsillectomy in children and in collaboration with the MCH sleep lab, directed by Dr Robert Brouillette, she published several papers on perioperative respiratory complications following tonsillectomy.
In collaboration with Dr Immanuella Moss, Respiratory Medicine, she reported a heightened respiratory opioid sensitivity in children with severe recurrent nocturnal hypoxemia.
In 2017, following reports of important post-tonsillectomy pain Dr Brown and colleagues conducted a prospective study asking parents to report their experience at home. The analysis of these data led to a collaboration with the BCU and is the subject of this talk.
Learning Objectives
At the completion of this talk, attendees will be able to:
- Describe the challenges presented by Real-World data obtained from the home environment;
- Discuss our analysis Methods: Missingness, MICE & the Fitting of Trajectory Models;
- Discuss the evaluation of the performance of this analysis and the interpretation of our results;
- Highlight the challenges of publishing in clinical journals.