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Preoperative preparation in children: a cross-sectional study
Z N Kain1, L C Mayes, L A Caramico
1Department of Anesthesiology, Yale Child Study Center, Yale University School of Medicine, New Haven, CT 06510-8051, USA.
Insights
A behavioral preparation program did not significantly reduce overall anxiety in children and parents before surgery. However, for children over six, the timing of the program, not just participation, impacted anxiety levels.
Area of Science:
- Pediatric Psychology
- Surgical Anxiety Management
- Behavioral Interventions
Background:
- Preoperative anxiety in children and parents is a significant concern.
- Behavioral preparation programs aim to mitigate this anxiety.
- Effectiveness may vary based on individual child factors.
Purpose of the Study:
- To evaluate the effectiveness of a behavioral preparation program for pediatric surgical patients and their parents.
- To identify factors influencing the program's success in reducing preoperative anxiety.
Main Methods:
- Cross-sectional study conducted in a children's hospital.
- 143 children undergoing outpatient surgery and their parents participated.
- A behavioral preoperative preparation program was administered.
Main Results:
- Overall anxiety levels did not differ significantly between intervention and control groups.
- For children over six, anxiety varied based on program timing: least anxious when received >5-7 days prior, most anxious when received 1 day prior.
- Child's age, timing of preparation, and prior hospitalization predicted anxiety.
Conclusions:
- Behavioral preoperative preparation programs are not universally effective for all pediatric outpatients.
- Intervention effectiveness is complex and influenced by child's age, timing of the program, and previous hospitalizations.
Study Objective:
To evaluate the effectiveness of a behavioral preparation program on reducing anxiety in children and their parents prior to elective surgery.
Design:
Cross-sectional study.
Setting:
A children's hospital.
Patients:
143 children undergoing outpatient surgery, and their parents.
Interventions:
A behavioral preoperative preparation program.
Measurements And Results:
Overall anxiety in children and their parents did not differ significantly between the group that received the preoperative program and the group that did not (p = NS). Children older than 6 years were least anxious on separation from their parents if they participated in the preparation program more than 5 to 7 days prior to surgery, moderately anxious if they did not receive preparation, and most anxious if they received the preparation 1 day prior to surgery (P = 0.04). Multivariable regression analysis (for overall model, F = 2.14, p = 0.02) revealed that although the preparation program itself was not a predictor of a child's behavior on separation to the operating room, the interaction between child's age and timing of the program (p = 0.003), and child's previous hospitalization were predictors of children's anxiety response. Similarly, in the preoperative holding area, independent predictors of anxiety included timing of the preparation program, age of child, and the child's baseline temperament characteristics.
Conclusions:
The results highlight the complexities in assuming that a behavior-based preoperative preparation program is effective for all pediatric outpatients. The effects of such an intervention vary with the child's age, the timing of the intervention, and a history of previous hospitalization.