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.