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The Effect of Multiple Surgeries on Psychosocial Outcomes in Pediatric Patients: A Scoping Review
Allison C Hu1, Anthony A Bertrand, Brian N Dang
1From the Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
Insights
Repetitive surgeries in pediatric patients can negatively impact psychosocial well-being, especially for those with complex congenital conditions. Further research is needed to understand the link between procedure numbers and disease complexity on these outcomes.
Area of Science:
- Pediatric Surgery
- Developmental Psychology
- Health Services Research
Background:
- Birth defects impact 3% of US infants annually, often requiring extensive, lifelong interventions.
- Reconstruction for congenital conditions involves multiple surgeries and therapies, posing a significant burden on developing children.
- These interventions may lead to long-term psychosocial challenges for pediatric patients.
Purpose of the Study:
- To investigate the psychosocial impact of repetitive surgical procedures on pediatric patients.
- To better define the relationship between the number of interventions and psychosocial outcomes in children with congenital conditions.
Main Methods:
- A scoping review was conducted following PRISMA-ScR guidelines.
- Searched PubMed, Cochrane Library, Science Direct, and Web of Science for studies on pediatric psychosocial outcomes and multiple surgeries.
- Included 25 English-language articles assessing psychosocial outcomes in pediatric patients undergoing more than one procedure.
Main Results:
- 25 studies (1995-2019) involving 6520 patients were reviewed.
- Congenital heart disease (CHD) and cleft lip/palate were common diagnoses.
- Repetitive surgeries were associated with poorer psychosocial outcomes in conditions like CHD, hydrocephalus, and bladder exstrophy, though some studies found no significant correlation.
Conclusions:
- Certain pediatric populations undergoing repetitive procedures are at risk for impaired psychosocial functioning.
- Differentiating the impact of surgery count versus disease complexity on psychosocial outcomes is crucial.
- Standardized psychosocial measures and prospective trials are needed to clarify these associations.
Background:
Birth defects affect 3% of all babies born in the United States each year. Unlike reconstruction for many acquired deformities, one hallmark of reconstruction for complex congenital conditions is the requirement of multiple surgeries, procedures, and therapies from birth to maturity. These interventions often result in significant medical burden on children during development with potential long-term psychosocial consequences. The aim of this study was therefore to better define the psychosocial impact of repetitive operations on the pediatric patient.
Methods:
A scoping review was performed under the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Review guidelines. We searched the PubMed, Cochrane Library, Science Direct, and Web of Science databases using key words "number of surgeries," "psychosocial," "pediatric," and related terms. Primary articles published in English describing psychosocial outcomes in pediatric patients who underwent more than one procedure or surgery were included (n = 25). The Newcastle-Ottawa Scale was used to assess the quality of each study.
Results:
We included 25 articles published between 1995 and 2019, which included 6520 patients. The most common diagnosis across all studies was congenital heart disease (CHD) (n = 4169, 63.9%), followed by cleft lip and palate (n = 1196, 18.3%). The average number of operations and procedures was 3.4 (range = 1-18) and 32.1 (range = 6-89), respectively. The association between repetitive surgeries and poorer psychosocial outcomes was demonstrated in children with early-onset scoliosis, CHD, hydrocephalus, bladder exstrophy, posterior urethral rupture, anorectal anomalies, and conditions requiring numerous nonsurgical procedures. There were also a few CHD, cleft lip and/or palate, and hydrocephalus studies that did not find a significant correlation.
Conclusions:
The studies here suggest that certain pediatric patient populations are at risk for impaired psychosocial functioning as a result of repetitive procedures. However, it is important to differentiate whether the association with poorer psychosocial outcomes is from the number of surgical procedures or whether the number if just a surrogate for increased disease complexity. Standardized psychosocial outcomes measures and future prospective, long-term, randomized clinical trials are also warranted.
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