Power, N.M.; (2010) Postoperative behaviour changes and pain in children, 2 to 12 years, following inpatient and day case surgery. Doctoral thesis , UCL (University College London).

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Abstract

may suffer negative outcomes following admission to hospital. Previous research in the USA, Finland, Sweden and Australia has shown that up to 54% of children exhibit problematic behaviours (PB) 2 weeks post-discharge and 16% at one month. Risk factors included higher child/parent pre-operative anxiety, child temperament, pre-surgical behavioural disturbances, younger age, premedication, and pain at home. The incidence of post-hospital PB in British children is not known and potential influencing variables have not been examined. The aims of this study were to describe and compare children’s post-hospital PB following day case or inpatient surgery and to examine the association of parent, child, pre-operative and in-hospital factors with parent and child anxiety, preparation for surgery and child posthospital PB and postoperative symptoms. A descriptive, repeated measures study design was used, involving self-report questionnaires, direct observation of behaviour and post-discharge questionnaire follow-up. Children, 2 to 12 years, scheduled for general, ENT and urology surgery under general anaesthesia were invited to participate. 73.3% children exhibited PB and 93.4% were in some pain (≥1, 0-10 NRS) on day 2 postdischarge from hospital. The incidence of PB and pain decreased significantly over the follow-up period with 31.8% children exhibiting PB and 25.2% experiencing pain at the end of week 4. PB and pain were associated with families taking additional time off work/school and increased follow-up healthcare. Following multivariate regression analyses, factors associated with PB were parents’ level of preparation for their child’s care at home, higher parent education, younger child age, the child’s previous pain experience, children who did not attend pre-admission clinics, child and parent anxiety, children who stayed overnight in hospital, and higher child pain intensity at home. The findings suggest that poorer parent self-efficacy in caring for their child in hospital and at home are associated with increased child negative outcomes at home.

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