Authors: Burns K et al.
Pediatric Anesthesia, April 27, 2026
This retrospective cohort study examined the relationship between socioeconomic status and emergence delirium (ED) in pediatric patients undergoing common outpatient procedures. Emergence delirium is a well-recognized postoperative phenomenon characterized by altered consciousness, agitation, or hypoactive behavior, particularly in children. While prior research has explored physiologic and anesthetic contributors to ED, the role of socioeconomic factors had not been previously evaluated.
The study analyzed pediatric patients undergoing three types of stimulating outpatient procedures: myringotomy, intestinal endoscopy, and dermatologic laser surgery. Standardized assessment tools were used, including the Modified Yale Pediatric Anxiety Scale (mYPAS) to measure preoperative anxiety and the Pediatric Anesthesia Emergence Delirium (PAED) scale to assess ED. Socioeconomic status was determined using the Area Deprivation Index (ADI), which categorizes patients based on neighborhood-level disadvantage derived from their home address.
Results demonstrated that children in the highest ADI category—representing the most socioeconomically disadvantaged group—had a significantly higher likelihood of experiencing emergence delirium compared to those in the lowest ADI category. This association persisted even after adjusting for age and postoperative pain scores, suggesting that the relationship is not solely explained by differences in pain or developmental factors.
The findings indicate that socioeconomic status may be an independent risk factor for emergence delirium. The authors suggest that factors associated with lower socioeconomic status, such as increased baseline stress, environmental instability, or heightened anxiety, may contribute to vulnerability in the perioperative period. This study represents the first evidence linking socioeconomic disadvantage to an anesthesia-related complication in pediatric patients.
Key Points
- First study to link socioeconomic status with emergence delirium in pediatric anesthesia
- Higher Area Deprivation Index (ADI) correlates with increased risk of ED
- Association persists even after controlling for pain and age
- Suggests non-physiologic factors (stress, environment, anxiety) play a role in ED
- Highlights opportunity for targeted preoperative interventions in higher-risk populations
What You Should Know
Emergence delirium is not purely an anesthetic or pharmacologic issue. This study suggests that a child’s socioeconomic background—likely reflecting underlying stress and anxiety—may significantly influence postoperative behavior. Identifying higher-risk patients preoperatively could allow anesthesia providers to adjust strategies, including anxiety reduction techniques, parental presence, or pharmacologic adjuncts, to improve outcomes.
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