Perioperative perceived-stress trajectories and associated factors among caregivers of children undergoing inguinal hernia surgery

Primary caregivers accompanying children through surgery pass through a rapid sequence of demanding perioperative events, and their perceived stress is unlikely to follow a single common course. Repeated caregiver data across the inguinal hernia pathway are scarce, and the heterogeneity of the response has not been formally characterized. To describe perioperative change in caregiver perceived stress, identify latent stress trajectories, and determine baseline factors associated with more severe trajectories. We analysed a retrospective longitudinal cohort of 438 child-caregiver dyads treated at a tertiary pediatric surgical center between 2022 and 2025. The 10-item Perceived Stress Scale (PSS-10, range 0 to 40) was recorded at admission (T0), one hour before surgery (T1), 6 to 12 h after surgery (T2), and before discharge (T3), with a day-3 assessment (T4) for 399 caregivers. Population change was modelled with a linear mixed-effects model, latent trajectories with one- to seven-class finite-mixture models, and associations with a prespecified baseline-only ordinal logistic model supported by extensive sensitivity analyses. PSS-10 scores were highest at T1, with population means of 17.07 at T0, 21.06 at T1, 13.15 at T3, and 11.24 at T4 (Wald chi-square 1829.20, P < 0.001). Five ordered classes were retained, and 24.9% followed a higher-score, incompletely recovering course. Urgent admission (adjusted odds ratio 2.30), lower social support (0.73 per 5 points), and previous surgical-caregiving experience (0.54) were associated with severity, stably across all analyses. Caregiver stress was highest before surgery but separated into five internally stable severity strata, marked by three admission-available factors. Because the PSS-10 references appraisal over the preceding month, the repeated scores are interpreted as global appraisals during a salient episode rather than as momentary state, which bounds how the trajectories should be read. Not applicable.