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Behavioural changes in children following day-case surgery: a 4-week follow-up of 551 children
L H Kotiniemi1, P T Ryhänen, I K Moilanen
1Department of Anaesthesiology, University of Oulu, Finland.
Insights
Children
Area of Science:
- Pediatric Surgery
- Child Psychology
- Behavioral Science
Background:
- Postoperative behavioral changes in children are common but not fully understood.
- Factors influencing these changes require further investigation to improve pediatric care.
- Understanding the duration and predictors of behavioral shifts is crucial for interventions.
Purpose of the Study:
- To evaluate the incidence and types of behavioral changes in children during the first four weeks after surgery.
- To identify patient-related factors predicting these behavioral changes.
- To assess the impact of hospital experiences on children's behavior post-surgery.
Main Methods:
- Prospective multicenter survey involving 551 children (4 months to 13.4 years).
- Pre- and postoperative parental questionnaires assessed behavioral changes.
- Multiple logistic regression analysis identified significant predictors of behavioral changes.
Main Results:
- Overall incidence of problematical behavioral changes was 47%, beneficial changes 17%.
- Problematical changes were most frequent in 1.0–2.9 year olds, decreasing significantly over 4 weeks.
- Key predictors included age, pain severity, and prior negative healthcare experiences; hospital play influenced behavior.
Conclusions:
- Effective postoperative pain management and positive healthcare interactions are vital for children's well-being.
- Pain on the day of surgery predicted behavioral issues for up to 4 weeks post-operation.
- Play may serve as a valuable tool to help children manage short hospital stays and surgical experiences.
Abstract:
The purpose of this prospective multicentre survey was to evaluate the occurrence and the type of changes in children's behaviour during the first 4 weeks following the day of surgery, and to assess the significance of some patient-related factors on the incidence. Pre- and postoperative questionnaires were completed by the parents of 551 children aged 4 months to 13.4 years in five hospitals incorporating nine operative units in Northern Finland. The overall incidence of problematical behavioural changes was 47% and that of beneficial changes 17%. Problematical changes were most common in the 1.0 to 2.9 year olds and the incidence decreased significantly from 46% on the day of the operation to 9% 4 weeks later (p < 0.0001). Predictors by multiple logistic regression analysis were age, mild pain at home following surgery, severe pain and a previous bad experience of health care which had adversely affected the attitude of the child towards doctors or nurses. Hospital influenced playing was a significant factor 3 and 4 weeks after the operation. By the 4th week, beneficial and problematical changes were equally common (9%). Gender, previous operations and experience of repeated paracenteses (for treatment of middle ear infection) did not have a significant effect on the incidence. Pain on the day of the operation predicted the occurrence of behavioural problems up to the 4th week, 2-4 weeks longer than the duration of pain itself. The results emphasise the importance of effective prevention of postoperative pain as well as the importance of avoiding unpleasant experiences in all contacts children have with health care. Playing could perhaps be used to help children cope with a short hospital experience.