Introduction
Preoperative anxiety is defined as an unpleasant emotional state characterized by feelings of tension, apprehension, nervousness, and worry before surgery [1]. The prevalence of preoperative anxiety among children undergoing surgery has been reported to range from 40% to 75% [2]. Anxiety in paediatric patients can lead to difficult anaesthetic induction, increased postoperative pain, emergence delirium, prolonged recovery, and negative behavioural changes after discharge [3,4]. Parents also experience significant anxiety when their child undergoes surgery. Studies suggest that parental anxiety directly influences the child's emotional response to surgery [5].Several factors have been implicated in the development of preoperative anxiety, including fear of pain and surgery, fear of anaesthesia and not waking up, separation from parents ,unfamiliar hospital environment, younger age, previous hospitalization, temperament, parental anxiety, lack of information regarding surgery and anaesthesia, socioeconomic status, and the magnitude of the planned procedure [6,7].The present study was undertaken to identify factors responsible for preoperative anxiety among children and their parents undergoing surgery.
Materials and Methods
The present Prospective observational study was conducted in the department of surgery in a tertiary care centre over a period of sixty months from January 2021 to January 2026. The formal ethical clearance from institutional ethical committee was obtained before initiation of the study. The Study Population involved Children aged 2–12 years scheduled for elective surgical procedures and one accompanying parent.
Inclusion Criteria
Children aged 2–12 years.
Elective surgical procedures under general anaesthesia.
Parent willing to participate.
Exclusion Criteria
Emergency surgeries.
Children with developmental delay or psychiatric illness.
Parents with diagnosed psychiatric disorders.
Refusal to participate.
A total of 200 child-parent pairs were enrolled. Data was Collected from both patients and parent and the following variables were recorded.
Child-related Variables
Age
Gender
Previous surgery
Previous hospitalization
Type of surgery
Duration of surgery
Nature of illness
Temperament
Parent-related Variables
Age
Gender
Educational status
Occupation
Socioeconomic status
Previous exposure to surgery
Anxiety regarding anaesthesia
Assessment of Anxiety
Child Anxiety
Modified Yale Preoperative Anxiety Scale (mYPAS) was used [8].
Parent Anxiety
State-Trait Anxiety Inventory (STAI) was administered [9].
Statistical Analysis
Data were analysed using SPSS version 25. Continuous variables were expressed as mean ± standard deviation. Independent t-test, Chi-square test, and Pearson correlation coefficient were used. A p-value <0.05 was considered statistically significant.
Results
Among 200 children, 118 (59%) were males and 82 (41%) were females. The mean age was 6.8 ± 2.9 years. The various Factors Associated with Child Anxiety, their percentage and p- value are shown in table-1.
| Variable | Anxiety (%) | P- Value |
| Age < 6 years | 72 | < 0.001 |
| First surgery | 68 | 0.002 |
| Previous negative hospitalisation | 74 | <0.001 |
| Major surgery | 70 | 0.01 |
| Inadequate counselling | 77 | <0.001 |
| High parental anxiety | 82 | <0.001 |
The various factors responsible for parental anxiety are shown in table-2.
| Variable | Anxiety (%) | P-Value |
| Low education status | 69 | 0.004 |
| First child undergoing surgery | 73 | 0.001 |
| Major surgery | 75 | < 0.001 |
| Lack of information | 81 | < 0.001 |
| Previous adverse surgical experience | 66 | 0.02 |
Correlation Analysis
A significant positive correlation was observed between parental STAI scores and child mYPAS scores (r = 0.68, p <0.001).
Discussion
Preoperative anxiety remains a significant challenge in paediatric surgical practice. Literature says that 40-75% of children experience significant preoperative anxiety, which is often mirrored by elevated anxiety levels in their parents. The effects of preoperative anxiety in children leads to difficult induction, increased post- operative pain, high analgesic requirement, emergence delirium, delayed recovery, sleep disturbances, nightmares and behavioural changes after surgery. The effects on the parents include emotional stress and psychological distress, difficulty in making informed decisions, reduced satisfaction with health care services and increased anxiety that may worsen the child’s anxiety. The present study identified younger age as an important predictor of anxiety. Younger children have limited cognitive ability to understand medical procedures and are therefore more vulnerable to fear and uncertainty [10]. Parental anxiety emerged as the strongest determinant of child anxiety. This finding is consistent with the observations of Kain et al., who demonstrated a direct relationship between parental emotional status and child anxiety during anaesthetic induction [5]. Lack of adequate preoperative information was another significant contributor. Previous studies have shown that structured counselling and preoperative educational programs can substantially reduce anxiety in both children and parents [11,12]. Children undergoing their first surgical procedure exhibited higher anxiety levels compared with those having previous positive surgical experiences. Similar findings have been reported by Davidson et al. [13]. Socio-economic and educational status influenced parental anxiety. Parents with lower educational attainment often reported difficulty understanding surgical and anaesthetic procedures, resulting in heightened anxiety [14]. The strong correlation between parental and child anxiety observed in this study supports family-centered interventions as an effective strategy for perioperative anxiety management.
Conclusion
Preoperative anxiety in children is multifactorial and is significantly influenced by:
Younger age.
First surgical experience.
Previous negative hospitalization.
Lack of adequate preoperative counselling.
Major surgical procedures.
High parental anxiety.
Lower parental educational status.
Targeted counselling, parental education, preoperative preparation programs, play therapy and distraction technique, videos, virtual reality, mobile applications, effective communication and reassurance from health care professionals and a family-centered perioperative care can significantly reduce anxiety and improve surgical outcomes.
Declarations
Ethics approval and consent to participate
The approval for the initiation of the present study was obtained from the institutional ethical committee GMC- Jammu. Written informed Consent/ Ascent was obtained from all participants.
Data Availability
Data are available from the corresponding author on reasonable request.
Conflicts of Interest
None
Funding Statement
No source of funding
Authors' contributions
WH and NA prepared the manuscript, SK and JI collected and compiled the data. Guidance during the process was provided by ZH. Every one read the manuscript before submission.
Acknowledgments
Not applicable