Dr. Rabbitts will present new findings from a multisite longitudinal cohort study examining changes in psychosocial factors in adolescents following spinal fusion surgery, and the influence on pain and recovery. To date, 141 youth (89% female; 56% White) aged 10-18 years (M=14.7) undergoing spinal fusion surgery were enrolled. Immediately after surgery, adolescents completed daily symptom monitoring for 30 days to characterize acute recovery. Participants completed repeated prospective assessments of pain outcomes over the year after surgery to identify pain outcomes. Participants reported on psychosocial factors (adolescent anxiety and depressive symptoms, pain catastrophizing) before surgery and at 8-weeks and 6-months post-surgery, in order to determine the temporal influence of these processes on pain persistence. Preliminary findings demonstrate 31.9% of youth reported moderate-severe pain and impaired quality of life at 6 months post-surgery (CPSP). Higher pain during the 30 days following surgery (OR=1.5,p=0.02), as well as greater increases in catastrophizing from pre- to 2 months post-surgery (OR=4.9,p=0.01) were associated with subsequent CPSP, while baseline pain and catastrophizing were not. Analyses will examine temporal pathways of psychosocial factors driving postsurgical pain. Future work will identify those with additional treatment needs, in order to optimize individualized perioperative treatment based on early recovery patterns.