Association between family environment and emergence delirium in pediatric patients after tonsillectomy and adenoidectomy: an observational prospective study

Abstract

Background

Preoperative anxiety in children is a known risk factor for Emergence Delirium (ED). The family environment may indirectly influence ED by modulating anxiety levels, but its direct role in ED remains unclear. The purpose of this study is to explore the associations between the occurrence of ED and family environmental factors in children. Identifying such associations may support the use of preoperative screening and targeted interventions to reduce ED risk.

Methods

In this prospective observational study, 334 children (3∼7 years) undergoing elective tonsillectomy/adenoidectomy were assessed. Preoperative visits recorded clinical data and used the Chinese Family Environment Scale (FES-CV) and State/Trait Anxiety Inventories (parental anxiety). Preoperative child anxiety was measured via modified Yale Preoperative Anxiety Scale (m-YPAS). ED was assessed postoperatively in PACU using the Pediatric Anesthesia Emergence Delirium scale (PAED ≥ 10).

Results

ED incidence was 21.9%. No significant association existed between overall home environment and ED. However, achievement orientation (FES-CV) negatively correlated with the m-YPAS score (m-YPAS; r = -0.139, p = 0.011). Independent ED risk factors identified: younger age (OR = 0.949, 95% CI 0.912∼0.988), introverted personality (OR = 0.393, 95% CI 0.184∼0.843), and higher postoperative pain (FLACC score; OR = 1.885, 95% CI 1.610∼2.208).

Conclusion

While no direct link between home environment and ED was found, the negative correlation between achievement orientation and preoperative anxiety suggests an indirect influence. Identifying high-risk children using factors like age, personality, and pain levels remains important for ED prevention.