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Preoperative anxiety in children. Predictors and outcomes
Z N Kain1, L C Mayes, T Z O'Connor
1Department of Anesthesiology, Yale University School of Medicine, New Haven, Conn, USA.
Insights
Child and parental anxiety predict preoperative anxiety in children undergoing surgery. While many children experience temporary behavioral changes post-surgery, long-term issues are rare.
Area of Science:
- Pediatric Psychology
- Surgical Anxiety Research
- Child Behavioral Health
Background:
- Preoperative anxiety in children is a significant concern.
- Identifying predictors and outcomes is crucial for intervention.
Purpose of the Study:
- To determine predictors of preoperative anxiety in children undergoing surgery.
- To evaluate the behavioral outcomes of this anxiety.
Main Methods:
- Prospective, longitudinal study of 163 children (2-10 years) and parents undergoing elective surgery.
- Anxiety assessed preoperatively and at separation using observational and self-report measures.
- Postoperative behavioral responses evaluated at 2 weeks, 6 months, and 1 year.
Main Results:
- Older children, children of anxious parents, and those with poor prior medical experiences showed higher preoperative anxiety.
- Child's temperament (low activity), previous hospitalization, and lack of daycare/premedication predicted separation anxiety.
- 54% of children had short-term behavioral issues; 7.3% had persistent problems at 1 year.
Conclusions:
- Maternal anxiety, child's temperament, age, and prior medical encounter quality predict preoperative anxiety.
- Most children experience transient behavioral changes post-surgery, with few developing long-term maladaptive responses.
Objective:
To determine predictors and behavioral outcomes of preoperative anxiety in children undergoing surgery.
Design:
A prospective, longitudinal study.
Setting:
A university children's hospital.
Participants:
One hundred sixty-three children, 2 to 10 years of age (and their parents), who underwent general anesthesia and elective surgery.
Main Outcome Measures:
In the preoperative holding area, anxiety level of the child and parents was determined using self-reported and independent observational measures. At separation to the operating room, the anxiety level of the child and parents was rated again. Postoperative behavioral responses were evaluated 3 times (at 2 weeks, 6 months, and 1 year).
Results:
A multiple regression model (R2 = 0.58, F = 6.4, P = .007) revealed that older children and children of anxious parents, who received low Emotionality, Activity, Sociability, and Impulsivity (EASI) ratings for activity, and with a history of poor-quality medical encounters demonstrated higher levels of anxiety in the preoperative holding area. A similar model (R2 = 0.42, F = 8.6, P = .001) revealed that children who received low EASI ratings for activity, with a previous hospitalization, who were not enrolled in day care, and who did not undergo premedication were more anxious at separation to the operating room. Overall, 54% of children exhibited some negative behavioral responses at the 2-week follow-up. Twenty percent of the children continued to demonstrate negative behavior changes at 6-month follow-up, and, in 7.3% of the children, these behaviors persisted at 1-year follow-up. Nightmares, separation anxiety, eating problems, and increased fear of physicians were the most common problems at 2-week follow-up. Multivariate analysis demonstrated that child's age, number of siblings, and immediate preoperative anxiety of the child and mother predicted later behavioral problems.
Conclusions:
Variables such as situational anxiety of the mother, temperament of the child, age of the child, and quality of previous medical encounters predict a child's preoperative anxiety. Although immediate negative behavioral responses develop in a relatively large number of young children following surgery, the magnitude of these changes is limited, and long-term maladaptive behavioral responses develop in only a small minority.