Medical clowns reduce pre-operative anxiety, post-operative pain and medical costs in children undergoing outpatient penile surgery: A randomised controlled trial

J Paediatr Child Health. 2016 Sep;52(9):877-81. doi: 10.1111/jpc.13242. Epub 2016 Jun 11.


Aim: The aim of this paper is to investigate prospectively the potential benefits of the participation of the medical clowns in the outpatient paediatric penile surgery programme.

Methods: Eighty children undergoing meatotomy, age 2 to 16 years, were randomised into two groups (40 each). In the first group, the medical clown was an integral part of the medical team, and in the second group, the treatment was given without participation of the medical clown. The following parameters were measured: the level of pre-operative anxiety, the level of the post-operative pain, the amount of pain medication use in the first 24 h after surgery and the time needed to return to normal activities. The operating room time and hospital costs were calculated.

Results: The patients from the first group demonstrated a lower pre-operative anxiety index upon (P = 0.0319) and after surgery (P = 0.0042), required less induction time for anaesthesia (P < 0.001), spent overall less time in the operating room (P < 0.0001) and required less time to recover from the surgery and to be discharged (P = 0.0172). The overall OR time and post-operative unit care savings of 20 and 155 min, respectively, led to the cost savings of $467.

Conclusion: Our data demonstrated that the use of the medical clown functioning as an integral part of the operating team reduces children pre-operative anxiety and leads to a shortening of the overall time in the hospital thereby reducing the overall medical cost justifying the participation of medical clown as an integral part of the health team in a paediatric urology outpatient surgical unit.

Keywords: anxiety; economical cost; meatotomy; medical clown; post-operative pain.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Ambulatory Surgical Procedures / economics
  • Ambulatory Surgical Procedures / psychology*
  • Anxiety / diagnosis
  • Anxiety / economics
  • Anxiety / etiology
  • Anxiety / prevention & control*
  • Child
  • Child, Preschool
  • Hospital Costs / statistics & numerical data
  • Humans
  • Israel
  • Laughter Therapy / methods*
  • Laughter Therapy / psychology
  • Male
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / economics
  • Pain, Postoperative / prevention & control*
  • Penis / surgery*
  • Perioperative Care / economics
  • Perioperative Care / methods*
  • Perioperative Care / psychology
  • Prospective Studies
  • Treatment Outcome
  • Urologic Surgical Procedures, Male / economics
  • Urologic Surgical Procedures, Male / psychology*