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Predictors and Outcomes

Zeev N. Kain, MD; Linda C. Mayes, MD; Theresa Z. O'Connor, PhD; Domenic V. Cicchetti, PhD

Arch Pediatr Adolesc Med. 1996;150(12):1238-1245.

Abstract
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.

Arch Pediatr Adolesc Med. 1996;150:1238-1245

Author Affiliations
From the Departments of Anesthesiology (Drs Kain and O'Connor), Pediatrics (Drs Kain and Mayes), and Psychiatry (Dr Cicchetti) and the Yale Child Study Center (Drs Mayes and Cicchetti), Yale University School of Medicine, New Haven, Conn.

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