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The effect of pediatric patient temperament on postoperative outcomes
Kristen Uhl1, Anna Litvinova1, Patcharee Sriswasdi1
1Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.
Insights
Children with excitable temperaments, showing high positive and negative emotionality, are more likely to experience significant postsurgical pain after tonsillectomy. Understanding child temperament can help predict pain outcomes.
Area of Science:
- Pediatric Anesthesiology
- Child Psychology
- Pain Management
Background:
- Limited data exists on the link between pre-existing child temperament and postsurgical outcomes.
- Identifying pediatric patients at risk for poor postsurgical outcomes remains a challenge.
Purpose of the Study:
- To investigate the relationship between preoperative child temperament and postoperative pain/behavioral outcomes.
- To identify specific temperament profiles that predict poor outcomes in children undergoing tonsillectomy/adenoidectomy.
Main Methods:
- Prospective study involving 260 children undergoing tonsillectomy/adenoidectomy.
- Parent-reported temperament surveys were collected preoperatively.
- Postoperative outcomes (pain, behavior, emesis) were gathered from electronic medical records and follow-up surveys.
Main Results:
- Temperament analysis identified four groups: positive, negative, excitable, and inhibitory.
- Temperament cluster was not significantly associated with emesis, agitation, or behavioral changes.
- The 'excitable' temperament cluster (high positive and negative emotionality) was significantly associated with higher reported postoperative pain (OR 7.97).
Conclusions:
- Preoperative child temperament influences pediatric postoperative pain.
- Children exhibiting high positive and negative emotionality may be at increased risk for experiencing more postsurgical pain.
Background:
Research has improved practitioner awareness of the impact of individual characteristics on responses to painful procedures. However, there is little data relating preexisting temperament profiles and postsurgical/anesthesia outcomes in pediatric patients. In particular, it is not clear how best to identify which patients are at risk of poor postsurgical outcomes.
Aim:
In this prospective study, we examined relationships between preoperative measures of child temperament and postoperative pain/behavioral outcomes of children undergoing tonsillectomy/adenoidectomy surgeries. We sought to determine which temperament profiles were predictive of poor outcomes.
Methods:
After IRB approval and informed consent, validated temperament surveys were administered to the parents of a cohort of children undergoing tonsillectomy/adenoidectomy surgery. These data were combined with preoperative, intraoperative, and postoperative outcome measures collected from the electronic medical record utilizing a large integrated anesthesia outcome database. The dataset was further augmented with surveys addressing remote postoperative behaviors. Analysis of the temperament data yielded four groups (positive, negative, excitable, and inhibitory). The probability of high perioperative pain, agitation, emesis, and postoperative behavior changes based on cluster membership was then assessed.
Results:
A total of 260 patients undergoing tonsillectomy and/or adenoidectomy surgeries were enrolled in the study. ANOVA and chi-squared analyses indicated no statistically significant age, gender, or anesthesia technique differences across the four temperament clusters. Temperament cluster membership was not related to emesis, agitation, or behavioral changes. However, it was found to be predictive of high postoperative pain. Members of the excitable cluster (high positive and negative emotionality) were more likely to report high pain than those in positive cluster (high positive, low negative emotionality) (OR 7.97, 95% CI: 1.62-39.26; P < 0.05). Comparisons among other clusters were not significant.
Conclusion:
Our data indicate that preoperative temperament characteristics may differentially influence pediatric postoperative pain experience in children. Specifically, children with high levels of positive and negative emotionality may exhibit more postsurgical pain behaviors.
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