Beyond pain: predictors of postoperative maladaptive behavior change in children

Abstract

OBJECTIVES & AIM: Using well-validated measures and controlling for potential confounding variables such as pain and surgical and anesthetic technique, the goal of this project was to identify the incidence of and risk factors for the development of behavior change in children after surgery. Although researchers have described maladaptive behavior change following surgery, many previous studies are limited by potential confounding variables, including postoperative pain, type of surgery, and surgical and anesthetic procedure. Participants included 260 children undergoing tonsillectomy and adenoidectomy. Baseline and demographic data were collected prior to surgery and pain and behavioral recovery were recorded for 2 weeks following surgery. A standardized approach to anesthesia and surgical procedure was implemented and well-validated assessment measures were used. On the first day at home following surgery, 80.4% of children exhibited negative behavior change. Nearly one-third of children continued to exhibit behavior changes 2 weeks after surgery. Logistic regression analyses that controlled for pain severity identified several predictors of behavior change: preexisting somatic and anxious/depressed problems predicted new onset postoperative general anxiety, chi(2) (8) = 20.10, P = 0.010; younger age predicted separation anxiety, chi(2) (4) = 20.41, P < 0.01; and inhibited temperament predicted postoperative sleep disturbance, chi(2) (2) = 9.19, P = 0.010. Individual child factors above and beyond pain predict maladaptive postoperative behavior change; identification of these predictors may be helpful in both preventing and ameliorating difficulties with behavioral recovery following surgery.