Inflammatory indicator levels in patients undergoing aortic valve replacement via median sternotomy with preoperative anxiety and postoperative complications: a prospective cohort study

Abstract

Objective This study was performed to evaluate the association of preoperative anxiety with inflammatory indicators and postoperative complications in patients undergoing scheduled aortic valve replacement surgery. Methods A prospective cohort study was performed. The Hamilton Anxiety Scale was used to assess preoperative anxiety. The serum white blood cell (WBC) count and concentrations of C-reactive protein, interleukin (IL)-6, and IL-8 were measured 1 day preoperatively and 3 and 7 days postoperatively. Postoperative complications were also recorded. Results Seventy-three patients were included. The incidence of preoperative anxiety was 30.1% (22/73). The payment source was the only independent risk factor for preoperative anxiety. The incidence of postoperative complications was lowest in the mild anxiety group. The WBC count 3 days postoperatively was significantly lower in the mild than moderate-severe anxiety group. The IL-8 concentration 1 day preoperatively was highest in the no anxiety group. Conclusions Mild preoperative anxiety might help to improve clinical outcomes. However, further investigations with more patients are warranted. Patients with different degrees of anxiety may have different levels of inflammatory cytokines.

Preoperative depression and anxiety as predictors of postoperative C-reactive protein levels in patients undergoing cardiac surgery: a prospective observational study

“…In addition, we found more severe anxiety symptoms as a marginally significant predictor of CRP levels on postoperative days 1-3, perhaps because depressive symptoms may affect the initiation of the acute inflammatory response to a greater extent than anxiety symptoms. Furthermore, our findings concur partially with a study on 73 patients who underwent aortic valve replacement that reported an association between clinically relevant anxiety symptoms before surgery and elevated CRP levels on postoperative day 3 [22]. However, in that study, no significant association was found 7 days post-surgery [22], and another study found an inverse as- Original article sociation between more severe anxiety symptoms before surgery and CRP levels 1 day after CABG, with no further significant associations until postoperative day 5 [23].…”

“…Additional analyses used depression and anxiety as binary variables. To obtain a more comprehensive understanding of the investigated associations and their dynamics, analyses were additionally performed with somatic depressive symptoms, cognitive depressive symptoms, and for two distinct postoperative periods; the latter also allowed comparison with previous studies [10,11,21,22]. To achieve this, instead of adding a time-by-depression or time-byanxiety interaction to the multivariable models, we explored whether depressive/anxiety symptoms predicted the initiation of the acute inflammatory response (postopera-…”

“…There may be several explanations for these inconsistent results. Previous studies used different measurement tools (i.e., Hamilton Anxiety Scale and State-Trait Anxiety Inventory), had smaller sample sizes, made no adjustments for covariates, and included patients undergoing one surgical procedure [22,23].…”

“…One study found that preoperative clinically relevant depressive symptoms significantly predicted increased CRP levels 4-8 days, although not 1-3 days, after CABG surgery [21]. A second study found a significant association between clinically relevant anxiety symptoms before surgery and higher CRP levels 3 days but not 7 days after aortic valve replacement [22]. In contrast, in a third study, more severe anxiety symptoms before surgery were significantly associated with lower CRP levels 24 h after CABG surgery, with no other significant associations on postoperative days 2-5 [23].…”

Personality, Preoperative Anxiety, and Postoperative Outcomes: A Review

“…Most patients are anxious during the preoperative period as a natural reaction to unpredictable and potentially threatening situations [89,90]. It has been shown that a curved, rather than a simple linear relationship, exists between preoperative anxiety and postoperative complications; for instance, the incidence of postoperative complications was significantly lower in patients with mild anxiety than in those without anxiety or with moderate-to-severe anxiety [91][92][93]. Although such a conclusion is still controversial [94], it is possible that mild anxiety promotes adaptive actions to cope with jeopardizing stimuli, thereby improving postoperative outcomes [91,93].…”