Profiles of Anxiety in Children Undergoing Elective Surgery: Predictors and Perioperative Outcomes

Surgery is an anxiety-provoking event, but there are individual differences in the magnitude of experienced anxiety. The objective of this study was to identify patterns of children's preoperative anxiety, its predictors, and perioperative outcomes. The sample included 171 children (M_age = 9.95 years) undergoing elective surgery. We derived groups of children's anxiety based on multiple indicators (i.e., self-report, heart rate, and frontal brain EEG activity) during a preoperative visit and on the day of surgery. Parents and children reported on children's temperament, children's behavior was coded in the operating room, and postoperative pain ratings were collected. Two latent profiles of children were identified, including a subset with relatively average anxious responses across indicators (74%) and a subset with relatively heightened anxious responses across indicators (26%). Children in the heightened anxiety subgroup had higher levels of temperamental shyness, displayed greater observed distress behaviors (e.g., resistance to anesthesia, screaming) upon operating room entry, and tended to have higher levels of postoperative pain compared to children in the average anxiety subgroup. These results reveal child-level predictors and perioperative outcomes associated with the experience of elevated anxiety in the surgical context.