B. Wong1, A. Melucci1, V. Dombrovskiy3, Y. Lee2,4 1Rutgers Robert Wood Johnson Medical School,New Brunswick, NJ, USA 2Rutgers Robert Wood Johnson Medical School,Pediatric Surgery,New Brunswick, NJ, USA 3Rutgers Robert Wood Johnson Medical School,Vascular Surgery,New Brunswick, NJ, USA 4Bristol Myers Squibb Children’s Hospital,New Brunswick, NJ, USA
Introduction:
Parental presence during induction of anesthesia (PPIA) has been used to reduce anxiety and increase patient satisfaction for pediatric surgical patients and their families. There remains variability in its implementation with anecdotal resistance from anesthesiologists and pediatric surgeons due to their concern about OR efficiency. However to date, there has been no formal study on the effect of PPIA on OR delay.
Methods:
A retrospective chart review of 1,590 children aged 1-12 years in a large academic children’s hospital who underwent same day elective ENT (ear/nose/throat) surgery (n=904), esophago/gastro/duodenoscopies (GI; n=200), or general surgical/urologic procedures (GS/UR; n=486) was performed. Those with the ASA (American Society of Anesthesiologists) physical status classification system grade > 3 or emergent were excluded from analysis. After approval from the surgeon and anesthesiologist, parents were offered PPIA and chose to be present (n=765) or not (n=825) during induction of general inhaled anesthesia. Surgical start time (SST, procedure start time minus wheels-in time) with and without parental presence was compared by Wilcoxon rank sum test and generalized linear gamma model with log link and adjustment for patient demographic characteristics and type of procedure.
Results:
Parental presence varied across procedures, comprising of 58% of ENT, 75% of GI, and 18% of GS/UR cases. Children with PPIA were younger with a median age of 4.5 years compared to 5.3 years without PPIA (p=0.003). Median parental presence ranged from 3-4 minutes and median SST ranged from 8-13 minutes depending on the procedure category. SST for GS/UR and GI cases were significantly longer than in ENT cases (p<0.0001) when controlling for age, gender and PPIA. Across all cases, each additional age year increased SST by 1.7% (p<0.001). There was no effect of gender on SST in ENT and GI cases; GS/UR patients were not analyzed as they were primarily male. When controlling for age, gender, and procedures, PPIA increased SST overall by 7.7% (p=0.0043), which is approximately 1 minute. Specifically, PPIA increased SST by 7.3% in ENT (p=0.042), 14.7% (p=0.046) in GI and made no difference in GS/UR patients (p=0.14). SST was significantly longer with PPIA for GS/UR patients aged 2-<6 years (p=0.043) and ENT and GI patients ≥6 years (p=0.009, p=0.003).
Conclusion:
PPIA increases SST for some surgical procedures and age groups, however the median overall delay of 1 minute is a small fraction of total OR time. Further research is needed to identify patients who may benefit from PPIA without negative impact on operating room efficiency.