Incidence and risk factors associated with negative postoperative behavioral changes in children undergoing painless gastroscopy

OBJECTIVE: To investigate the incidence of and risk factors associated with negative postoperative behavioral changes (NPOBCs) in children undergoing painless gastroscopy. METHODS: Inclusion criteria: ASA I–II and outpatients aged 6–12 years undergoing painless gastroscopy. Exclusion criteria: history of surgery or anesthesia, children with developmental or intellectual abnormalities, refusal to participate, preoperative abdominal pain score > 3 points, history of chronic abdominal pain of > 3 months duration, and serious intraoperative complications. On the 1st, 14th, and 30th day after the gastroscopy, the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) was used to assess NPOBCs in children. RESULTS: A total of 1,670 children were included in this prospective observational cohort study. The incidence rates of NPOBCs were 14.13%, 4.55%, and 2.14% on the 1st, 14th, and 30th day after gastroscopy, respectively. The risk factors for the first day were female sex (OR 1.34, 95% CI 1.00–1.79), parental anxiety (OR 2.23, 95% CI 1.75–3.12), and severe anxiety in children (OR 2.83, 95% CI 1.96–4.07). The risk factors on the 14th day were parental anxiety (OR 3.71, 95% CI 2.19–6.29), a parental educational level above high school (OR 1.65, 95% CI 1.00–2.70), and severe anxiety in children (OR 11.87, 95% CI 5.85–24.07). The risk factors on the 30th day were female sex (OR 2.99, 95% CI 1.41–6.34), being an only child (OR 4.42, 95% CI 2.18–8.95), a parental educational level above high school (OR 2.66, 95% CI 1.27 NPOBCs 5.56), and severe anxiety in children (OR 6.84, 95% CI 2.84–16.49). CONCLUSION: In children undergoing painless gastroscopy, the incidence rates of NPOBCs on the 1st, 14th, and 30th day were 14.13%, 4.55%, and 2.14%, respectively. The risk factors for NPOBCs were severe anxiety in children, female sex, parental anxiety, and a parental educational level above high school. In particular, severe preoperative anxiety in children was a persistent risk factor for NPOBCs within 30 days.