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PEDIATRIC ANESTHESIA

What Postoperative Outcomes Matter to Pediatric Patients?

Giovanni Cucchiaro, MD^*, John T. Farrar, MD, PhD, Jessica W. Guite, PhD^*, and Yuelin Li, PhD^*

*Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia; and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia

Address correspondence to Giovanni Cucchiaro, MD, Department of Anesthesia and Critical Care Medicine, The Children’s Hospital of Philadelphia, 34th St. and Civic Center Blvd., Philadelphia, PA 19104. Address e-mail to Cucchiaro{at}email.chop.edu.

Children are often excluded from making decisions related to their medical treatment, and parents’ proxy reports are often used. This approach fails to consider that parents and children may differ in their perception of the child’s health. In this study, we assessed children’s decision-making processes related to postoperative pain management. Forty-five children who underwent an anterior cruciate ligament repair or Nuss procedure for pectus excavatum repair were studied. A standard gamble technique was used to assess children’s perceptions of the utility of a hypothetical treatment that would provide them with perfect pain control, with respect to different rates of risk for vomiting during the postoperative period. The maximum risk of vomiting that the overall study population was willing to accept to decrease the pain level to zero was 32% ± 24%. Girls were willing to take a significantly higher risk (41% ± 24%) compared to boys (25% ± 22%) (P = 0.02). Children who actually experienced vomiting before they were questioned were willing to take a higher risk (46% ± 26%) compared to those who did not (23% ± 17%) (P = 0.035). Children can express opinions about preferred postoperative outcomes and provide useful input about their care. Girls, more than boys, seem to perceive vomiting as less important than improved pain control in the postoperative period.

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