Anxiety in neurosurgical patients undergoing nonurgent surgery during the COVID-19 pandemic

Abstract

OBJECTIVEThe COVID-19 pandemic has forced many countries into lockdown and has led to the postponement of nonurgent neurosurgical procedures. Although stress has been investigated during this pandemic, there are no reports on anxiety in neurosurgical patients undergoing nonurgent surgical procedures.METHODSNeurosurgical patients admitted to hospitals in eastern Lombardy for nonurgent surgery after the lockdown prospectively completed a pre- and postoperative structured questionnaire. Recorded data included demographics, pathology, time on surgical waiting list, anxiety related to COVID-19, primary pathology and surgery, safety perception during hospital admission before and after surgery, and surgical outcomes. Anxiety was measured with the State-Trait Anxiety Inventory. Descriptive statistics were computed on the different variables and data were stratified according to pathology (oncological vs nononcological). Three different models were used to investigate which variables had the greatest impact on anxiety, oncological patients, and safety perception, respectively. Because the variables (Xs) were of a different nature (qualitative and quantitative), mostly asymmetrical, and related to outcome (Y) by nonlinear relationships, a machine learning approach composed of three steps (1, random forest growing; 2, relative variable importance measure; and 3, partial dependence plots) was chosen.RESULTSOne hundred twenty-three patients from 10 different hospitals were included in the study. None of the patients developed COVID-19 after surgery. State and trait anxiety were reported by 30.3% and 18.9% of patients, respectively. Higher values of state anxiety were documented in oncological compared to nononcological patients (46.7% vs 25%; p = 0.055). Anxiety was strongly associated with worry about primary pathology, surgery, disease worsening, and with stress during waiting time, as expected. Worry about positivity to SARS-CoV-2, however, was the strongest factor associated with anxiety, even though none of the patients were infected. Neuro-oncological disease was associated with state anxiety and with worry about surgery and COVID-19. Increased bed distance and availability of hand sanitizer were associated with a feeling of safety.CONCLUSIONSThese data underline the importance of psychological support, especially for neuro-oncological patients, during a pandemic.

Early prediction of in-hospital death of COVID-19 patients: a machine-learning model based on age, blood analyses, and chest x-ray score

“…The Relative Variable Importance Measure (rel VIM) (Carpita and Vezzoli, 2012), (Doglietto et al, 2020b) and the Partial Dependence Plots (PDP) (Friedman, 2001) (Doglietto et al, 2020a) were extracted from the model for a better understanding of the relationship between outcome and covariates.…”

Preoperative anxiety among patients scheduled for elective surgical procedures duringthe COVID-19 pandemic – A cross-sectional study in a tertiary care teaching hospital in India

“…In our study, 25% of the study population had the anxiety trait. This was comparable to the study done by Doglietto et al .,[ 7 ] among the neurosurgical patients posted for non-urgent surgery during the COVID-19 pandemic in Italy, where 18.9% of their study population had the anxiety trait. Further, 12% of the patients in our study population displayed anxiety due to general preoperative factors which was found to be lower as compared to a study done by Vadhanan et al .,[ 5 ] among preoperative patients in India, where the figure was 30%.…”

“…A total of 7.1% of our study population expressed anxiety specifically due to COVID-19-related factors as compared to 30.3% in the study by Doglietto et al . [ 7 ] This study was conducted during the immediate post-lockdown phase in Lombardy which had been one of the epicentres of the COVID-19 pandemic in Italy. In comparison, our study was conducted at a time when restrictions had been eased, and the COVID-19 cases were markedly fewer.…”

Postoperative chronic pain incidence and etiology in coronary artery bypass graft surgery: a prospective study

“…After the appearance of the first cases of COVID-19 on 10 March 2020 in Turkey, there was no significant difference between patients undergoing OHC before the pandemic and after the pandemic when we evaluated preoperative anxiety levels and POCP rates of the preoperative anxiety levels. In Italy, where the course of the pandemic is intense, high preoperative anxiety levels were found in non-emergency neurosurgery patients during the COVID-19 pandemic [28]. This difference may be due to geographic location or different types of operations.…”