A cross sectional survey investigating the prevalence of preoperative anxiety in children, and if this is associated with cultural and socio-economic background at Rahima Moosa Mother and Child Hospital, South Africa.
Background: A significant number of children appear to experience anxiety in the preoperative period, which may lead to maladaptive postsurgical behaviour. The aim of this study was to conduct a survey to determine the prevalence of preoperative anxiety in children, and to investigate any associations with cultural and socio-economic factors. The study also aimed to determine the need for additional interventions to reduce preoperative anxiety and whether socio-economic and cultural factors allowed for the identification of children at particular risk of anxiety. Methods: The sample included 113 participants, aged 2-12 years, undergoing minor elective surgery under general anaesthesia at Rahima Moosa Mother and Child Hospital in Johannesburg. All eligible children were included in the survey and were not separated from their parents in the waiting area or operating theatre. Anxiety levels were measured in the waiting room, on entering the operating theatre, and at induction of anaesthesia, using the modified Yale Preoperative Anxiety Scale (m-YPAS). Demographic and socio-economic details were obtained via a short questionnaire. Results: m-YPAS scores of >30 are considered to demonstrate high anxiety. Children were significantly (p<0.01) more anxious on entering theatre (m-YPAS median score of 41 [23-55] ), and on induction of anaesthesia (46 [23-61] ), than in the waiting area (23 [23-41] ). m-YPAS scores were >30 in 30% of children in the waiting area, 52% of children on entering the operating theatre, and 56% of children at induction of anaesthesia. Older children experienced less anxiety, which was statistically significant (correlation with age r = - 0.48, p <0.01). Demographic and socio-economic factors (sex of the child, race, language, nationality, parent’s education, parent’s employment, parent’s income, and single parenthood) were not shown to have a significant association with an increase in anxiety in the child at induction of anaesthesia. Conclusion: Children experienced significant anxiety in the preoperative period particularly during induction of anaesthesia, which is comparable with previous studies, despite maintaining parental presence. Socio-economic and cultural factors do not appear to predict anxiety, although the sample size was not adequately powered to draw conclusions. Reduction of preoperative anxiety therefore requires further consideration in our setting for selected children, which may involve the use of additional psychological or pharmacological techniques.