Overview of studies by surgery type
| Author | Measures | Sample (N) | Quality rating | Type of surgery | Summary of findings |
| A. Cardiac surgery | |||||
| Connolly et al15 | DISC | Children (43) | 5 | Cardiac. | 12% of children met diagnostic criteria for PTSD post surgery. 12% had symptoms but did not meet full criteria. Length of hospital stay was the only significant predictor of postoperative PTSD (r=0.19). |
| Franich-Ray et al24 | ASDS | Parents (135) | 7 | Cardiac. | 27% of parents met diagnostic criteria for ASD 1 month post surgery. Dissociative symptoms were the most frequently endorsed symptom cluster. |
| Helfricht et al25 | PDS | Parents (233) | 4 | Cardiopulmonary bypass. | 15% of parents met diagnostic criteria for PTSD post surgery. The rate was 12% at 6-month follow-up. Length of hospital stay significantly related to PTSD (fathers only). Being of non-native nationality was related to increased PTSD. |
| Landolt et al26 | PDS | Parents (232) | 3 | Cardiopulmonary bypass. | 25% of parents met criteria for PTSD at discharge. 34% had partial PTSD. Those with full or partial PTSD were significantly more likely to report lower mental health-related quality of life. |
| Stokes et al27 | PCL-S; PAT | Parents (31) | 5 | Cardiac. | 7% of parents met diagnostic criteria for ASD at 2 years post surgery, as did 18% of those lost to follow-up. Depression, anxiety and operative complications of prolonged mechanical ventilation were significantly associated with PTSD. |
| B. Mixed surgery | |||||
| Ben-Ari et al32 | UCLA-PTSD; PTSDSSI; PAT; PDS | Children and parents (235) | 7 | Various, for example, urology, ENT. | Higher parental distress, stress regarding social support and parental concerns regarding sibling problems predicted child PTSD. |
| Ben-Ari et al21 | UCLA-PTSD; PDS | Children and parents (88) | 7 | Various, for example, urology, ENT. | 10% of children met full PTSD diagnostic criteria 5 months post surgery. 12% of parents met criteria for full PTSD. There was a significant correlation between child and parent PTSD (r=0.417). |
| Ben-Amitay et al14 | CPTS-RI | Children (39) | 5 | Various, for example, otolaryngology, orthopaedics. | 21% of children scored in the mild-moderate range for PTSD. At 6 months post surgery, child PTSD was positively associated with mother’s depression scores (r=0.52). |
| Liu et al22 | ASDS | Children (105) | 4 | Various. | 54% of children met full diagnostic criteria for ASD post surgery. Participants were victims of the Wenchuan earthquake of 2008. |
| Nagata et al28 | IES-R | Parents (145) | 6 | Various, for example, inguinal hernia, biliary atresia. | 20% of parents met criteria for PTSD. Factors associated with higher PTSD levels were state and trait anxiety, current condition of the child (r=−0.351), likelihood of future operations (r=0.297), distance from support (r=0.229) and disease severity (r=0.214). |
| Scrimin et al29 | PSSI | Parents (154) | 5 | Day, minor and major surgery, for example, appendicitis, craniotomy. | 16% of parents met full criteria for ASD post surgery. Traumatic stress was higher in major surgery groups compared with day surgery and in those with less social support and fewer years of education. |
| C. Other surgery | |||||
| Beaudoin et al30 | PCL-5 | Parents (168) | 7 | Neurosurgery. | 45% of parents met criteria for PTSD. Parents of children who had greater than three surgeries had higher levels of PTSD symptomology. PTSD rates were also influenced by the type of neurosurgical procedure the child underwent and their diagnosis. |
| Ben-Ari et al23 | PTSDSSI; PCASS; PDS | Children and parents (30) | 5 | Congenital melanocytic nevi removal. | 33% of children met criteria for PTSD 4 months post surgery. Invasive medical procedures, family resources and parental distress predicted 40% of the variance in distress. For parents, 63% rated surgery as a traumatic event and 27% met PTSD diagnostic criteria. |
| Ari et al13 | PTSDSSI; PCASS | Children (79) | 6 | General paediatric not specified. | Five months post surgery, 56% of children had significant symptoms of re-experiencing, 30% avoidance and 33% hyperarousal. 26% of parents reported being very concerned about the child’s fears since the surgery. |
| Bevilacqua et al16 | IES-R | Parents (170) | 5 | Congenital malformation. | 48% of parents met criteria for PTSD 6 months post surgery. Length of hospital stay was a significant predictor of PTSD (F(5, 156)=11.745). Surgery and condition-related anomalies and days of mechanical ventilation were associated with PTSD. |
| Karadeniz Cerit et al17 | CAPS | Parents (60) | 4 | Oncology, for example, neuroblastoma, Wilms’ tumour. | 22% of parents met diagnostic criteria for PTSD post surgery. Duration of hospital stay was significantly longer in parents with PTSD than in those without. |
ASDS, Acute Stress Disorder Scale; CAPS, Clinician-Administered PTSD Scale for DSM-5; CPSS, Child PTSD Symptom Scale; CPTS-RI, Children’s Post-traumatic Stress Reaction Index; DISC, Diagnostic Interview Schedule for Children; ENT, Ear Nose and Throat; IES-R, Impact of Event Scale-Revised; PAT, Psychosocial Assessment Tool; PCASS, Preschool Children’s Assessment of Stress Scale; PCL-5, PTSD Checklist for DSM-5; PCL-S, PTSD Scale-Specific; PDS, Post-traumatic Stress Diagnostic Scale; PSSI, Post-traumatic Stress Symptom Inventory; PTSDSSI, Post-traumatic Stress Disorder Semi-Structured Interview; UCLA-PTSD, The University of California at Los Angeles Posttraumatic Stress Disorder Reaction Index; UCLA-PTSD, UCLA-PTSD Reaction Index.