Family-centered Preparation for Surgery Improves Perioperative Outcomes in Children

TLDR

Preoperative anxiety and distress are common among children and parents, and existing interventions have limited efficacy. The authors aimed to develop a family‑centered behavioral preparation program (ADVANCE) for children undergoing surgery. In a randomized trial of 408 families, participants were assigned to standard care, parental presence, the ADVANCE program, or oral midazolam, and outcomes such as anxiety, analgesic use, and emergence delirium were measured. The ADVANCE group showed significantly lower preoperative anxiety, reduced emergence delirium, less analgesic consumption, and earlier recovery room discharge compared with the other groups.

Abstract

Background Children and parents experience significant anxiety and distress during the preoperative period. Currently available interventions are having limited efficacy. Based on an integration of the literature in both the anesthesia and psychological milieus, the authors developed a behaviorally oriented perioperative preparation program for children undergoing surgery that targets the family as a whole. Methods Children and their parents (n = 408) were randomly assigned to one of four groups: (1) control: received standard of care; (2) parental presence: received standard parental presence during induction of anesthesia; (3) ADVANCE: received family-centered behavioral preparation; and (4) oral midazolam. The authors assessed the effect of group assignment on preoperative anxiety levels and postoperative outcomes such as analgesic consumption and emergence delirium. Results Parents and children in the ADVANCE group exhibited significantly lower anxiety in the holding area as compared with all three other groups (34.4+/-16 vs. 39.7+/-15; P=0.007) and were less anxious during induction of anesthesia as compared with the control and parental presence groups (44.9+/-22 vs. 51.6+/-25 and 53.6+/-25, respectively; P=0.006). Anxiety and compliance during induction of anesthesia was similar for children in both the ADVANCE and midazolam groups (44.9+/-22 vs. 42.9+/-24; P=0.904). Children in the ADVANCE group exhibited a lower incidence of emergence delirium after surgery (P=0.038), required significantly less analgesia in the recovery room (P=0.016), and were discharged from the recovery room earlier (P=0.04) as compared with children in the three other groups. Conclusion The family-centered preoperative ADVANCE preparation program is effective in the reduction of preoperative anxiety and improvement in postoperative outcomes.