Intraoperative text messaging to reduce parental stress during outpatient pediatric surgery: a randomized trial

This study examined parental stress indicators during outpatient pediatric surgery and whether intraoperative text messaging could alleviate stress.

This randomized trial assigned parents of children aged 6 months to 6 years undergoing minor outpatient surgery to an intervention group, receiving standardized intraoperative text messages, or a control group without messages. Both groups received a postoperative phone call. Stress was assessed using salivary cortisol, heart rate, heart rate variability, and subjective ratings at multiple perioperative time points.

Fifty-one families participated, predominantly mothers (71%). Cortisol and heart rate variability peaked preoperatively, while heart rate and subjective stress were elevated pre- and intraoperatively regardless of messaging. Fathers had lower cortisol at the end of surgery, heart rate pre- and postoperative and subjective stress at pre-treatment consultation compared to mothers, who exhibited lower heart rate variability the evening before surgery. Messaging reduced postoperative cortisol and intraoperative subjective stress among fathers but increased subjective stress at surgery onset within mothers and had no significant effect on stress indicators across the full cohort.

Intraoperative text messaging reduced stress in fathers but not in mothers or the full cohort. The preoperative period remained the most stressful. Future research should explore gender-specific strategies to improve perioperative parental support.

This study assessed parental stress during outpatient pediatric surgery and the impact of intraoperative text messaging as a supportive intervention. Text messages reduced stress in fathers but showed minimal benefit and potential adverse effects in mothers, with increased subjective stress at surgery onset; no overall stress reduction was observed in the full cohort. The preoperative phase was identified as the most stressful for parents. These findings inform pediatric surgical teams that text-based interventions may support fathers' perioperative coping and postoperative compliance but may be ineffective or counterproductive for mothers, highlighting the need in future research for gender-sensitive stress-reduction strategies.