Psychological Influences on Postoperative Recovery

描述（由申请人提供）：本竞争性续作旨在扩展一项正在进行的纵向项目（R01HD37007-01），研究手术儿童人群术前焦虑与术后行为和临床恢复之间的关系。在美国有超过五百万的儿童接受手术。据估计，多达75%的儿童在手术前会出现极度焦虑。在成人中，术前极度焦虑已被证明与术后临床结果相关，如疼痛和镇痛需求，以及恢复和住院时间延长。在儿童中，除我们最初应用的数据外，没有同行评审和发表的关于术前行为压力和焦虑加剧是否会损害术后恢复的结果数据。这个问题非常重要，因为有几种有效的干预措施可用于治疗儿童术前焦虑。不幸的是，目前有减少这些术前干预的强烈趋势。这种趋势很可能是由于目前的医疗经济环境和缺乏记录术前焦虑和术后恢复之间联系的儿童结果数据。在我们的初步应用中，我们已经证明，儿童术前高度焦虑与术后疼痛增加以及临床和术后行为恢复受损有关。因此，我们的研究结果表明，旨在减少术前焦虑的干预措施将改善术后恢复过程。在过去的几年里，我们的实验室已经开发并验证了许多这样的干预措施。因此，在研究的下一阶段，我们提出了一项随机对照试验，以检查各种术前干预对术后行为和临床恢复过程的影响。这将通过综合临床、神经内分泌和行为测量来评估。作为次要目标，我们将(1)评估各种类型的术前干预对上述假设的影响，以及(2)检查这些术前干预在不同年龄组的有效性和一致性。本研究的广泛、长期目标是评估、发展和实施术前干预措施，以改善术后行为和临床恢复过程。

DESCRIPTION (provided by applicant): This competing continuation seeks to extend an ongoing longitudinal project (R01HD37007-01) examining the relations between preoperative anxiety and postoperative behavioral and clinical recovery in a population of children undergoing surgery. Over five million children undergo surgery in the United States. It is estimated that up to 75 percent of these children develop extreme anxiety prior to their surgery. In adults, extreme preoperative anxiety has been shown to correlate with postoperative clinical outcomes such as pain and analgesic requirements, and prolonged recovery and hospital stay. In children, excluding data from our initial application, there are no peer reviewed, published outcome data regarding the question of whether heightened preoperative behavioral stress and anxiety impairs postoperative recovery. This issue is of extreme importance as several effective interventions are available to treat preoperative anxiety in children. Unfortunately, there is currently a strong trend towards reduction in these preoperative interventions. This trend is most likely a result of the present medical-economic climate and the absence of outcome data in children documenting a link between preoperative anxiety and postoperative recovery. In our initial application, we have demonstrated that high levels of preoperative anxiety in children are associated with increased postoperative pain and impaired clinical and behavioral postoperative recovery. Thus, our results suggest that interventions aimed at the reduction of preoperative anxiety will improve the postoperative recovery process. Over the past several years our laboratory has developed and validated a number of such interventions. Thus, in the next phase of the study, we propose a randomized controlled trial that will examine the impact of various preoperative interventions on the postoperative behavioral and clinical recovery process. This will be assessed by convergent clinical, neuroendocrinological, and behavioral measures. As secondary aims we will (1) evaluate the impact of various types of preoperative interventions in children to the above hypothesis, and (2) examine the effectiveness and consistency of these preoperative interventions across various age groups. The broad, longterm objectives of this research are the evaluation, development and implementation of preoperative interventions that will improve the postoperative behavioral and clinical recovery process.