Effect of preoperative anxiety, depression, and insomnia on acute postoperative pain after non-cardiac surgery

Abstract

Background The mental diseases especially anxiety, depression, and insomnia are common in patients at perioperative period. This study aims to investigate the association of preoperative mental diseases with acute postoperative pain of patients undergoing non-cardiac surgery. Method: The patients undergoing non-cardiac surgery from August 1, 2019 to January 23, 2020 at Capital Medical University, Beijing Chao-Yang Hospital were included in this retrospective study. The demographics, clinical data and assessments of depression, anxiety, and insomnia by Insomnia Severity Index (ISI), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) were collected and analyzed. The patients with any of depression, anxiety or insomnia were divided into mental disease group, and others were in non-mental disease group according to the. We compared the postoperative visual analog score between patients in mental diseases group with propensity score matching cohort from patients in non-mental diseases. The primary outcome was acute postoperative pain according to the Visual Analog Scale (VAS) 24h after surgery. Secondary outcomes included VAS at other time points and incidence of postoperative nausea and vomiting (PONV), rescue analgesia, and length of hospital stay (LOS). Results The analysis included 397 patients (274 in the group and 123 in the mental disease group). Patients in mental disease group (anxiety, depression and insomnia) were associated with higher VAS scores and increased times of rescue analgesia. Each of the 3 mental diseases was associated with higher VAS scores independently. Conclusion In this retrospective study, preoperative anxiety, depression and insomnia were associated with increased the level of acute postoperative pain and increased times of rescue analgesia of patients undergoing non-cardiac surgery.