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[Psychotrauma associated with ambulatory and inpatient surgery in infants. A prospective study]
W Büttner1, L Breitkopf, J Engert
1Klinik für Anaesthesiologie und Operative Intensivmedizin, Ruhr-Universität Bochum.
Insights
Day-case surgery and inpatient care showed no significant psychological differences in children aged 2-6 years. Postoperative behavioral changes were minimal and comparable between both surgical approaches.
Area of Science:
- Pediatric Psychology
- Surgical Outcomes Research
Background:
- Day-case surgery is presumed to cause less psychological distress in children than inpatient care.
- Existing studies lack methodologically valid evidence to support or refute claims about the psychological impact of day-case versus inpatient surgery.
- Medical psychologists often favor short-term hospitalization with parental presence over traditional day-case surgery.
Purpose of the Study:
- To prospectively investigate the psychogenic effects of non-acute surgery under general anesthesia in young children.
- To compare psychological alterations between children undergoing day-case surgery and those requiring inpatient care.
Main Methods:
- A controlled, prospective study involving 52 children (2-6 years old) undergoing non-acute surgery.
- Children were divided into day-case (n=24) and inpatient (n=28) groups (ASA I and II).
- Mothers were interviewed 6 and 12 weeks post-operation to assess children's psychological changes; the interviewer was blinded to treatment allocation. Preoperative anxiety in children and mothers was also measured.
Main Results:
- No significant differences in preoperative anxiety or postoperative psychological findings were observed between day-case and inpatient groups.
- Psychological changes reported by mothers were infrequent and generally minimal across both groups.
- Factor analysis identified two main behavioral factors: 'emotional confusion/troublesome behavior' and 'flexible play/increased concentration'.
Conclusions:
- Day-case surgery and inpatient care appear to have comparable psychogenic effects on young children undergoing non-acute surgery.
- The overall incidence of significant postoperative psychological disturbances is low for both surgical approaches.
- Further research may explore the nuances of parental presence and specific surgical factors influencing child behavior.
Abstract:
The presumed advantages of day-case surgery are often based on the argument that this kind of surgery induces less psychic harm in children than inpatient care. However, medical psychologists in particular increasingly prefer short-term hospitalization with rooming-in or daily visits by the mother. Neither opponents nor supporters of day-case surgery could produce valid findings from controlled and methodically valid studies of this subject. MATERIAL AND METHODS. A controlled, prospective study of the psychogenic effects of non-acute surgery under general anesthesia in children between 2 and 6 years of age was performed. The childrens' psychologic alterations were measured 6 and 12 weeks after the operation using a structured interview of the mother. Twenty-four children were treated by day-case surgery, 28 as inpatients. All children belonged to ASA groups I and II. The interviewer was "blind" to the indication, kind of surgery and duration of hospitalization. The mothers' answers concerning the postoperative behavior of their children were coded in terms of frequency of changes (seldom, unchanged, more frequent) or intensity (vigorous, unchanged, slight) in comparison to the time before operation. The data were compared to the anxiety of the children and mothers before premedication. The childrens' anxiety was measured using the scoring system of Büttner and Breitkopf; the mothers' anxiety was measured using a modified scoring system according to Groeger and Grosse-Aldenhövel. RESULTS. 1. There were no significant differences between the day-case and the stationary groups, in either preoperative anxiety assessments or postoperative psychological findings. 2. In comparison with the total number of possible psychologic effects, the number that really occurred was very small; only in 6 of 81 items did more than one-third of the mothers report any changes. 3. Most items were reported as minimal changes. Therefore, all items had to be analyzed using the method of analysis of factors (mean components, varimax rotation, Scree-test). Within 44.7% of extracted variance there were 2 factors involving behavior. Items applying to factor 1 included disturbed sleep and increased attachment of the child to the parents, indicating "emotional confusion" or "troublesome behavior." Factor 2 indicated a more flexible manner of playing and increased ability to concentrate.4+