Definition and Overview
A paediatric pre-surgery follow-up is an appointment with a surgeon to discuss a planned surgical procedure that will be performed on a patient below 18 years old. At this stage, the patient’s parents or guardians have already agreed to the surgical procedure but require the surgeon to address their questions and concerns. This is normal as surgery is associated with risks and possible complications. It is also during this consultation that the surgeon provides final instructions on how to prepare the child for the procedure. These include whether or not the patient needs to stop eating or drinking or taking his usual medications in the hours before surgery. Parents or guardians are also given a list of what to bring to the hospital, information on how long the surgery will take, and how long the child is expected to stay in the hospital following the procedure.
Who Should Undergo and Expected Results
A paediatric pre-surgery follow-up is a requirement for all young people who are scheduled to undergo surgery, regardless of the techniques to be used (whether open surgery or minimally invasive techniques). These include infants, toddlers, young children ages 2-10 years old, adolescents aged 10-12, and teenagers. Once the surgery is confirmed and scheduled, the surgeon will schedule a follow-up visit that must be attended by the patient and at least one parent or guardian.
During the follow-up visit, the following details will be discussed:
- The benefits of the procedure
- The risks involved
- Instructions for preparing the child for the procedure
- Eating and drinking guidelines before the surgery
- What to expect during the recovery period
- What to bring to the hospital on the surgery date
- How to manage post-surgical pain
At the end of the visit, the patient and his family would have a clear picture of the procedure and how it is going to be performed. They will also be equipped with information on how to prepare for it.
How the Procedure Works?
A paediatric pre-surgery follow-up is usually scheduled around a week prior to the procedure itself, and takes place at the office or clinic of the surgeon or in the hospital. If requested by the patient, the anaesthesiologist may also be present. The meeting may take up to an hour to make sure all details are discussed.
Examples of questions that patients and their guardians should ask during this visit are the following:
- How long will the surgery take?
- Can my child eat or drink anything before the surgery?
- Will my child be given anything to help him relax before the procedure?
- Will I still see the surgeon prior to the procedure?
- When will I see my child after the surgery?
- Can I stay with my child until he wakes up?
- How long is the recovery period?
- Who will administer the anaesthesia and what kind of anesthesia will be used?
- What will my child’s condition be like upon waking up?
- What should we expect or be prepared for while my child is recovering from the procedure?
Usually, at this point, the patient has been assessed for surgery, but if there are still some more tests necessary, the surgeon may order these before the surgery date.
It is also possible for parents to schedule a pre-operative tour. This may not be necessary for older patients, but may be extremely helpful for children. The tour can include the patient, his parents or guardians, as well as his siblings. This will allow the patient to see the hospital and interact with the medical staff, and can thus help him feel more at ease in the environment he will be exposed to during and after the surgery. Preoperative tours are facilitated by medical staff members and may be scheduled within the week before the surgery. These have been shown to help young patients overcome their fears of being in the hospital.
Possible Risks and Complications
A paediatric pre-surgery follow-up plays an important role in preventing various risks and complications associated with surgery, which include:
- Blood clots
- Allergy to anaesthetics
- Muscle atrophy
There are also special considerations and challenges in paediatric surgery, and these have to be discussed and resolved prior to the scheduled date. These may differ depending on the age of the patient.
Infants and toddlers may not be comfortable about being separated from their parents, so it is important to find some means to soothe them, such as bringing along a familiar toy, blanket, or pacifier.
Patients aged 2 to 6, or very young children, are more challenging because they already understand a bit of what is happening. Thus, it is important for parents and guardians to explain the process, such as how long they will need to stay at the hospital, what to expect there, and who will help care for them. It is important to establish trust between the patient and the surgeon and hospital staff.
Patients aged 6 to 12 as well as teenagers may already have their own questions about the procedure. Thus, they should also be given the chance to voice these out and their questions must be taken seriously.
The paediatric pre-surgery follow-up is the best time to discuss these challenges and how they can be resolved, so the surgery can go as planned when the scheduled date finally comes.
Chung DH. Pediatric surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 13.
Neumayer L, Vargo D. Principles of preoperative and operative surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 11.