Background

Mindset, or one's beliefs about the ability to change one's outcomes, has been studied in the educational domain but not in surgical settings. The purpose of this study was to examine the role of parental health mindset on children's recovery.

Methods

Participants were part of a larger National Institutes of Health-funded trial that included 1470 children undergoing outpatient tonsillectomy and adenoidectomy. We used measures of parental coping style (Monitor Blunter Style Scale; MBSS) and medication attitudes (Medication Attitudes Questionnaire; MAQ) to validate the Health Beliefs Scale (HBS; Criterion validity, Cohen's kappa). HBS categorizes parents as having a growth mindset, or the belief that health can be changed, or a fixed mindset, which reflects the belief that individuals cannot change their health. Next, we identified demographic and personality variables (eg, temperament, anxiety) as predictors for the HBS. Finally, we examined the relationship between the HBS with postoperative outcomes.

Results

Findings supported criterion validity of the HBS. Parents with a growth mindset reported seeking out more medical information (MBSS, 7.15 ± 3.32 vs 6.22 ± 3.38, P < .001, CI = -1.387 to -0.471) and reported fewer misconceptions regarding analgesic use (MAQ, 22.11 ± 4.09 vs 21.41 ± 4.25, P = .035, CI = 0.046 to 1.229). In assessing outcomes, we found that fixed-mindset parents rated their children's postoperative pain as more severe on days 1 (9.22 ± 3.82 vs 8.37 ± 3.71, P = .007, CI = 0.234 to 1.459) and 3 (8.13 ± 4.28 vs 7.27 ± 4.28, P = .007, CI = 0.094 to 1.638) and reported that their children received more doses of ibuprofen on postoperative day 1 (2.91 ± 1.24 vs 2.44 ± 1.44, P = .041, CI = 0.089 to 0.848). There was no difference in children's self-reported pain scores between groups (P = .585).

Conclusions

These findings, coupled with recent mindset intervention studies in the educational space, suggest that parent mindset is an important target for clinical intervention in the context of children's surgical recovery.

Background/objectives

The present study examined whether parental perceptions of children's pain impacted home-based pain management following outpatient surgery in a sample of Latino families from low socioeconomic backgrounds.

Methods

Latino parents of children (n = 161) who underwent outpatient surgery were recruited for this study and completed measures assessing attitudes on pain and analgesic use (Parental Pain Expression Perceptions and Medication Attitudes Questionnaire) before their child's surgery. Parents also rated their child's pain after their child's surgery using the Parent Postoperative Pain Measure and collected data on the amount of analgesics they gave to their child on the first postoperative day. Hierarchical regression analyses examined whether parental attitudes predicted pain assessment and management at home.

Results

A majority of parents reported multiple misconceptions regarding children's pain and fears of side effects as well as avoidance of analgesic use. For example, over 80% reported believing that a child always tells their parents when they are in pain. Hierarchical regression analyses found that more fear and avoidance regarding analgesic use for children's pain predicted parents providing fewer doses of analgesic to their children on the first postoperative day (β = -0.21, P = 0.028).

Conclusions

Preoperative parents' beliefs regarding analgesics for treatment of children's pain may adversely impact parent postoperative analgesic administration at home in Latino families.

Background

COVID-19 forced healthcare systems to make unprecedented changes in clinical care processes. The authors hypothesized that the COVID-19 pandemic adversely impacted timely access to care, perioperative processes, and clinical outcomes for pediatric patients undergoing primary appendectomy.

Methods

A retrospective, international, multicenter study was conducted using matched cohorts within participating centers of the international PEdiatric Anesthesia COVID-19 Collaborative (PEACOC). Patients younger than 18 yr old were matched using age, American Society of Anesthesiologists Physical Status, and sex. The primary outcome was the difference in hospital length of stay of patients undergoing primary appendectomy during a 2-month period early in the COVID-19 pandemic (April to May 2020) compared with prepandemic (April to May 2019). Secondary outcomes included time to appendectomy and the incidence of complicated appendicitis.

Results

A total of 3,351 cases from 28 institutions were available with 1,684 cases in the prepandemic cohort matched to 1,618 in the pandemic cohort. Hospital length of stay was statistically significantly different between the two groups: 29 h (interquartile range: 18 to 79) in the pandemic cohort versus 28 h (interquartile range: 18 to 67) in the prepandemic cohort (adjusted coefficient, 1 [95% CI, 0.39 to 1.61]; P < 0.001), but this difference was small. Eight centers demonstrated a statistically significantly longer hospital length of stay in the pandemic period than in the prepandemic period, while 13 were shorter and 7 did not observe a statistically significant difference. During the pandemic period, there was a greater occurrence of complicated appendicitis, prepandemic 313 (18.6%) versus pandemic 389 (24.1%), an absolute difference of 5.5% (adjusted odds ratio, 1.32 [95% CI, 1.1 to 1.59]; P = 0.003). Preoperative SARS-CoV-2 testing was associated with significantly longer time-to-appendectomy, 720 min (interquartile range: 430 to 1,112) with testing versus 414 min (interquartile range: 231 to 770) without testing, adjusted coefficient, 306 min (95% CI, 241 to 371; P < 0.001), and longer hospital length of stay, 31 h (interquartile range: 20 to 83) with testing versus 24 h (interquartile range: 14 to 68) without testing, adjusted coefficient, 7.0 (95% CI, 2.7 to 11.3; P = 0.002).

Conclusions

For children undergoing appendectomy, the COVID-19 pandemic did not significantly impact hospital length of stay.

Editor’s perspective

Background

Pediatric anesthesiology has been greatly impacted by COVID-19 in the delivery of care to patients and to the individual providers. With this study, we sought to survey pediatric centers and highlight the variations in care related to perioperative medicine during the COVID-19 pandemic, including the availability of protective equipment, the practice of pediatric anesthesia, and economic impact.

Aim

The aim of the survey was to determine how COVID-19 directly impacted pediatric anesthesia practices during the study period.

Methods

A survey concerning four major domains (testing, safety, clinical management/policy, economics) was developed. It was pilot tested for clarity and content by members of the Pediatric Anesthesia COVID-19 Collaborative. The survey was administered by email to all Pediatric Anesthesia COVID-19 Collaborative members on September 1, 2020. Respondents had six weeks to complete the survey and were instructed to answer the questions based on their institution's practice during September 1 - October 13, 2020.

Results

Sixty-three institutions (100% response rate) participated in the COVID-19 Pediatric Anesthesia Survey. Forty-one hospitals (65%) were from the United States, and 35% included other countries. N95 masks were available to anesthesia teams at 91% of institutions (n = 57) (95% CI: 80%-96%). COVID-19 testing criteria of anesthesia staff and guidelines to return to work varied by institution. Structured simulation training aimed at improving COVID-19 safety and patient care occurred at 62% of institutions (n = 39). Pediatric anesthesiologists were economically affected by a reduction in their employer benefits and restriction of travel due to employer imposed quarantine regulations.

Conclusion

Our data indicate that the COVID-19 pandemic has impacted the testing, safety, clinical management, and economics of pediatric anesthesia practice. Further investigation into the long-term consequences for the specialty is indicated.