Preoperative sleep-related problems and their association with postoperative agitation, pain, and early postoperative sleep-related problems in children undergoing orthopedic surgery.

BACKGROUND: Sleep-related problems play an important role in children's physiological and psychological recovery following surgery. Preoperative sleep-related problems may intensify stress responses, increase postoperative agitation and pain, and negatively affect postoperative sleep regulation. OBJECTIVE: This study examined the association between preoperative sleep-related problems and postoperative agitation, pain, and sleep outcomes in pediatric patients undergoing orthopedic surgery. METHODS: This descriptive prospective study design with a retrospective component included 104 children with a mean age of 9.79 ± 3.01 years who underwent orthopedic surgery at a university hospital. Data were collected using the Pediatric Anesthesia Emergence Delirium (PAED) Scale, Watcha Behavior (WBS) Scale, Face, Legs, Activity, Cry, Consolability (FLACC) Scale, and a caregiver-reported numerical rating form assessing sleep-related problems. Preoperative sleep-related problems were evaluated retrospectively for the seven days prior to hospitalization. Postoperative outcomes were assessed immediately after transfer from the post-anesthesia care unit and on postoperative day 1. Data were analyzed at a significance level of p < 0.05. RESULTS: Postoperative sleep-related problems significantly increased across all domains compared with preoperative values. Postoperative agitation and pain scores were higher in the immediate postoperative period and decreased by postoperative day 1. Significant positive correlations were found between preoperative sleep-related problems and postoperative agitation and pain scores. CONCLUSION: Preoperative sleep-related problems were associated with higher levels of postoperative agitation, pain, and sleep-related problems in children undergoing orthopedic surgery. Early identification of sleep-related problems by pediatric surgical nurses may support targeted perioperative nursing interventions and improve postoperative recovery outcomes.