Surgery for Kids: Send in the Clowns!

Surgery causes high levels of stress in 50% to 75% of children, but humor and laughter can help children cope with pain and stress.

As such, many hospitals employ medical clowns to bring joy and happiness to patients. Previous research had shown clowns improved the self-perception of children undergoing gastroenterology procedures or sexual abuse exams. Another study used clowns to reduce pain and anxiety associated with venous blood draws. Previous research has not explored the impact of medical clowns on surgery-related medical costs.

Furthermore, an article published ahead-of-print in the Journal of Paediatrics and Child Health indicated that medical clowns reduced pre-operative anxiety and post-operative pain, shortened overall medical costs, and reduced time to return to normal activities after outpatient penile surgery in children.

The study randomized eighty children between two and 16 years old undergoing penile meatotomy in a 1:1 ratio into clown-inclusive and clown-exclusive arms. The study excluded previously anesthetized children. The researchers quantified preoperative anxiety with the 22-item modified Yale Preoperative Anxiety Scale Instrument and pain with the “Face and Legs activity, Cry, Consolability” scale for patients younger than three years old and Wong-Baker Faces scale for older children.

The clown-accompanied patients reported less anxiety, required less time for induction of anesthesia, and used less time in the operating room (OR).

Patients at the researchers’ institution were 96% receptive to the inclusion of clowns into the pre-operative workflow but Vagnoli et al. documents clowning in a less receptive environment. Only one family in the clown arm had a negative impression of the clown.

This institution’s clowns undergo education on the treated medical conditions, surgical anatomy, functions of the OR (e.g. garbing), and roles of the members of the OR team. Clowns reduced OR time by 6% and saved $467. Additional revenue can be generated by scheduling more procedures per OR as well.

The authors concluded that clowns reduce pre-operative stress, post-operative pain, and expedite anesthesia induction in pediatric penile meatotomy patients, and they call for additional research on larger and broader surgical patient populations.