Perspectives of Children, Parents, and Healthcare Providers on Outcomes after Anesthesia for Surgery
An International Mixed Methods Stakeholder Engagement Study from the Pediatric Perioperative Outcomes Group.
Anesthesiology
Submitted July 2026 by Dr Erika Strazdins
Review summary
What defines a ‘good’ anaesthetic for a child? Is it uneventful airway management, a cannula that goes in the first time, and physiologic stability? Or a positive and pain free experience that they are not afraid to face again?
This original research explores how children, parents, and healthcare professionals prioritise outcomes in paediatric anaesthesia, and the barriers to and facilitators of positive and negative experiences. While some outcomes such as pain management, emotional wellbeing, and relationships are shared, their meaning and importance diverge across groups in ways that shape the overall experience. These findings, as well as an imbalance between the groups in areas such as education and safety provide insight into why a technically perfect anaesthetic as viewed by a clinician may still feel like a difficult experience for a child and their family. This research challenges traditional perioperative outcome measures, and supports the development of a more patient and family centered paradigm.
Key findings
Patients and parents experienced anaesthesia as a longitudinal journey beginning at admission and ending back at home, whereas clinicians conceptualised it as a discrete episode of care.
Safety was prioritised by clinicians (102/136 responses), yet was overwhelmingly underrepresented in parent and patient narratives (29/172 and 12/51). This paradox may reflect a differing awareness of risk or the implicit trust that safety is assured.
Parents strongly emphasised education as a key facilitator of a positive anaesthetic experience (161/172), contrasting with only slightly more than half of providers (77/136). This suggests that parents desire more information than healthcare providers anticipate or routinely provide.
Perhaps unsurprisingly, parents experienced routine aspects of perioperative care, such as prolonged fasting, as significant contributors to distress and behavioural dysregulation.
Often differences between the groups were not absolute but reflected variation in emphasis, expectations, and lived experience in these domains. For instance, while pain emerged as a shared priority in patients, parents, and providers, the emotional meaning differed. Providers often framed pain as an inevitable consequence of surgery, whereas patients and parents experienced it as a potentially modifiable determinant of recovery quality, impacting mobility, sleep, and overall wellbeing. Patients and parents discussed the social and emotional support they received and the comfort of their environment as facilitators of recovery. These factors were strongly echoed by health care providers.
Finally, there was agreement across groups on what constitutes an ideal outcome: minimal pain, absence of complications, and no lasting negative emotional impact or fear of future procedures.
Strengths
This is original research specifically seeking patient relevant clinical outcomes in paediatric anaesthesia. Semistructured interviews facilitated an exploration of experiences, values and priorities beyond what quantitative methods can capture.
This qualitative research had sound methodology, with clear application of Modified Grounded Theory, transparent coding processes, and attention to researcher background.
359 interviews, across 8 countries, and multiple stakeholder groups improves ecological validity. In addition, our Oceania region was well represented in the sample group, increasing local relevance. The inclusion of multi disciplinary health care providers including anaesthetists, surgeons, and nurses, strengthens the relevance across the perioperative pathway.
Limitations
Patient perspectives (51) were comparatively underrepresented, with interviews weighted toward parents (172) and healthcare providers (136). The exclusion of children less than 8 as interviewees means that the younger children’s experiences were captured indirectly through parent perspectives, which may not fully reflect the child’s lived experience.
Notably, patient interviews were only conducted in North America and Oceania, limiting the cultural generalisability of children’s perspectives.
The parent cohort was highly educated (60% university or higher), potentially limiting generalisability across diverse cultural and health literacy contexts.
Although internationally diverse, the sample was predominantly from Western countries, and Caucasian (64% of patients, 51% of parents, and 61% of providers), which may limit the cultural generalisability of findings. There were limited First Nations peoples.
The study focused on lower-risk (ASA ≦3) elective surgical populations, limiting applicability to more complex or high-risk cohorts and to non-surgical procedures (such as endoscopy, interventional radiology, imaging).
Bottom line
For children and their families, the success of anaesthesia is not measured in physiological stability, but in how the experience feels for the entire health care episode well before, during, and long after their surgery.
This study reveals shared foundations, but significant divergence between health care provider defined outcomes and the lived experience of paediatric anaesthesia. While safety and minimising complications remains essential to our practice, pain, education, emotional wellbeing, and the hospital environment shape how anaesthesia is remembered by children and their parents. These differences suggest that improving paediatric anaesthesia is not just a technical challenge, but a relational and communicative one.
It provides a compelling foundation for developing child and family centred outcome measures, and challenges us to rethink what success in paediatric anaesthesia means.
