Children who are anxious before surgery experience a more painful, slow, and complicated postoperative recovery, according to a Yale School of Medicine study published this month in Pediatrics.

The study is important, said lead author, Zeev Kain, M.D., professor in the Departments of Anesthesiology, Pediatrics, and the Yale Child Study Center, because more than five million children in the United States undergo surgery every year and up to 45 percent experience significant stress and anxiety prior to surgery.

In his five-year study supported by the National Institutes of Health (NIH), Kain and his team recruited 241 children aged five- to 12-years-old who were scheduled to undergo elective tonsillectomy and adenoidectomy. The personality characteristics of the children and their parents were assessed before the surgery. All of the children were admitted to a research unit at Yale following the surgery and postoperative pain and analgesic consumption were recorded every hour. After 24 hours in the hospital, the children were discharged and followed up at home for the next 14 days.

The researchers found that anxious children experienced more problems emerging from anesthesia and significantly more pain both during the hospital stay and over the first three days at home. During home recovery anxious children also consumed significantly more codeine and acetaminophen and had a higher incidence of postoperative anxiety and sleep problems.

"The results of our study indicate that decreasing the anxiety of children before surgery will result in improved recovery after surgery, reduced pain, and lower hospital costs," Kain said. "But ongoing randomized, controlled trials are needed to clearly draw this conclusion." Kain and his colleagues currently are examining this issue in an NIH funded study.

Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC.
Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery.
Pediatrics. 2006 Aug;118(2):651-8.   [Abstract]