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ORIGINAL ARTICLE
Search terms
Anxiety, child, pain, postoperative,
preoperative, surgery.
Author contact
nurhhg@nus.edu.sg, with a copy to the Editor:
roxie.foster@ucdenver.edu
Acknowledgements
We appreciate the former director of nursing,
Ms. Lee Heng Pheng, the nurse managers, and
nurse clinicians of the participating wards, KK
Womens and Childrens Hospital, for their
support to this study. We give our heartfelt
thanks to all children and their parents for their
participation. This study did not receive any
specic grant from any funding agency in the
public, commercial, or not-for-prot sectors.
Abstract
Purpose. The purpose of this study was to examine the influencing factors
of postoperative pain among children undergoing elective surgery.
Design and Methods. A survey was conducted in 2011 with a convenience sample of 66 children, 6 to 14 years old, in a tertiary hospital in
Singapore.
Results. Children experienced moderate preoperative anxiety and postoperative pain. Gender, preoperative anxiety, and negative emotional
behaviors were significant influencing factors for postoperative pain. Boys
reported less postoperative pain than girls.
Practice Implications. Effective strategies for assessing and managing
childrens preoperative anxiety are needed to achieve an optimal postoperative pain management outcome.
Author contributions
Study Design: HHG, CWCS, YJSC;
Data Collection and Analysis: YJSC, HHG, JLLW,
CWCS, PKY, WW;
Manuscript Preparation: HHG, CWCS, YJSC, PKY,
WW, JLLW.
Disclosure: The authors report no actual or
potential conicts of interest.
First Received October 21, 2012; Final revision
received February 27, 2013; Accepted for
publication February 28, 2013.
doi: 10.1111/jspn.12030
Exploring Inuencing Factors of Postoperative Pain in School-Age Children Undergoing Elective Surgery
Exploring Inuencing Factors of Postoperative Pain in School-Age Children Undergoing Elective Surgery
METHODS
Design and sample
Exploring Inuencing Factors of Postoperative Pain in School-Age Children Undergoing Elective Surgery
Ethical approval was obtained from the ethics committee of the participating hospital prior to data collection. All children were recruited on a voluntary
246
Exploring Inuencing Factors of Postoperative Pain in School-Age Children Undergoing Elective Surgery
cally interpreted as small, medium, and large coefficients, respectively. The independent samples t-test
and analysis of variance were used to test the differences among preoperative anxiety, CEMS scores, and
postoperative pain among groups. Multiple linear
regression analysis was used to identify the predictors
for postoperative pain from a set of independent variables, including demographic and clinical variables,
preoperative anxiety, and preoperative negative
emotional behaviors. p-values less than .05 were
considered statistically significant. Cronbachs alpha
values were used to determine the internal consistency reliability of the instruments.
FINDINGS
Childrens demographic and clinical information
Subgroups
Gender
Boy
Girl
Age (years)
68
911
1214
Ethnicity
Chinese
Malay
Indian
Other
Previous hospitalization Yes
No
Type of surgery
Otolaryngologic surgery
Orthopedic surgery
Plastic and reconstructive surgery
Ophthalmologic surgery
Neurosurgery
Other
Time of admission
Day before
Same day
As shown in Table 2, there was no significant difference in childrens SAS-C (short form) scores, preoperative CEMS scores, and postoperative pain
intensity comparing demographic groups.
Relationships among preoperative anxiety,
preoperative negative emotional behaviors,
and postoperative pain
n (%)
38 (58)
28 (42)
20 (30)
21 (32)
25 (38)
40 (61)
18 (27)
6 (9)
2 (3)
30 (45)
36 (55)
27 (41)
12 (18)
11 (17)
2 (3)
2 (3)
12 (18)
34 (52)
32 (48)
Exploring Inuencing Factors of Postoperative Pain in School-Age Children Undergoing Elective Surgery
Table 2. Comparison of Childrens SAS-C (Short Form) Scores, CEMS Scores, and Postoperative Pain Intensity Across Their
Subgroups of Demographics (N = 66)
SAS-C
Demographics
Subgroups
M (SD)
Gender
Boy
Girl
68
911
1214
Chinese
Malay
Indian
Other
Singapore citizen
Singapore PR
Other
Primary
Secondary
Yes
No
Otolaryngologic
Orthopedic
Plastic and reconstructive surgery
Ophthalmologic
Neurosurgery
Other surgery
Day before
Same day
38
28
20
21
25
40
18
6
2
58
3
5
54
12
30
36
27
12
11
2
2
12
34
32
19.9 (4.7)
18.7 (5.2)
19.6 (5.2)
20.1 (4.8)
18.6 (5.0)
19.5 (4.7)
19.5 (5.0)
20.2 (6.2)
14.0 (5.7)
19.6 (5.1)
18.0 (1.0)
17.2 (5.0)
19.4 (5.0)
19.4 (5.1)
20.1 (4.7)
18.9 (5.1)
18.9 (4.8)
18.2 (5.0)
21.0 (5.8)
20.0 (2.8)
21.0 (1.4)
20.8 (4.6)
18.9 (5.6)
19.8 (4.1)
Age (years)
Ethnicity
Nationality
Educational level
Previous hospitalization
Type of surgery
Time of admission
CEMS
t/F
(p)
t = .94
(.35)
F = .54
(.58)
F = .84
(.48)
F = .68
(.51)
t = -.03
(1.00)
t = 1.03
(.31)
F = .82
(.54)
t = -.74
(.46)
M (SD)
7.6 (1.9)
7.2 (1.6)
7.9 (2.4)
7.4 (1.5)
7.1 (1.4)
7.4 (1.8)
7.9 (1.9)
7.0 (.9)
5.5 (.7)
7.5 (1.8)
7.0 (1.7)
6.8 (2.2)
7.6 (1.8)
6.9 (1.6)
7.8 (1.5)
7.1 (1.9)
6.8 (1.2)
7.6 (1.8)
7.2 (1.5)
8.0 (1.4)
5.5 (.7)
8.3 (2.2)
7.1 (1.6)
7.8 (1.9)
F = .46
(.64)
t = 1.12
(.27)
t = 1.65
(.10)
F = 1.60
(.17)
t = -1.81
(.08)
M (SD)
3.6 (2.6)
4.7 (2.5)
3.8 (3.0)
4.6 (2.3)
3.8 (2.5)
3.7 (2.6)
5.2 (2.6)
3.5 (2.3)
2.5 (.7)
4.1 (2.7)
4.0 (1.0)
3.0 (2.2)
4.2 (2.7)
3.5 (2.3)
4.4 (2.7)
3.8 (2.5)
3.9 (2.8)
4.1 (2.9)
4.7 (2.6)
4.5 (.7)
2.0 (2.8)
3.8 (2.1)
4.2 (2.8)
3.8 (2.5)
t/F
(p)
t = -1.7
(.09)
F = .74
(.48)
F = 1.89
(.14)
F = .43
(.65)
t = .80
(.43)
t = .91
(.36)
F = .43
(.83)
t = .61
(.55)
Note: CEMS, Childrens Emotional Manifestation Scale; M, mean; SAS-C, State Anxiety Scale for Children; SD, standard deviation; Singapore PR,
Singapore permanent resident.
such as tonsillectomies with or without adenoidectomy were the most frequently performed pediatric
surgical procedures in the participating hospital,
which is similar to international studies (Crandall
et al., 2009; Huth et al., 2004; Kain et al., 2006). The
majority of children admitted to the study site for
surgery were 614 years old.
Our study results found that children reported a
moderate level of preoperative anxiety. This result
Most of the participants (41%) underwent otolaryngology surgery. Otolaryngology surgical procedures,
Table 3. Multiple Regression Analysis for the Predictors Associated With Postoperative Pain (N = 66)
95% CI
Predictor variables
Lower bound
Upper bound
Gender
Agea
Ethnicity
Previous hospitalization
Type of surgerya
Time of admission
Preoperative anxietya
Preoperative negative emotional behaviorsa
.26
-.03
-.12
.04
-.05
.16
.26
.28
2.23
-.22
-1.03
.34
-.38
1.33
2.04
2.14
.03*
.82
.30
.73
.70
.19
.04*
.03*
.14
-.28
-1.89
-1.03
-.57
-.42
.003
.03
2.59
.23
.60
1.45
.38
2.08
.27
.80
Note: *p < .05. aVariables were treated as continuous variables. b = standardized beta coefficient, t = t-test statistics, p = significance value, 95% CI =
95% confidence interval for b; Gender: 1 = Girls, 0 = Boys; Ethnicity: 1 = Chinese, 0 = other ethnicity; Previous hospitalization: 1 = Yes, 0 = No; Time
of admission: 1 = day before admission, 0 = same-day admission.
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Exploring Inuencing Factors of Postoperative Pain in School-Age Children Undergoing Elective Surgery
Exploring Inuencing Factors of Postoperative Pain in School-Age Children Undergoing Elective Surgery
250
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