Preoperative anxiety and its association with patients’ desire for support - an observational study in adults

Abstract

Background Preoperative anxiety is prevalent and has harmful effects on postoperative outcomes. However, to date, it is still unclear (i) to what extent patients perceive preoperative anxiety as emotionally distressful, (ii) whether patients would welcome support from anesthesiologists in coping with their anxiety, and (iii) whether anxiety scores are useful for everyday clinical practice to determine patients’ need for support. Methods: 1082 patients scheduled to undergo elective procedures under general anesthesia were eligible for this cross-sectional study carried out at a university hospital. Preoperative anxiety, resulting in emotional distress, and patients’ desire for anesthesiologists’ support in coping with their anxiety were assessed dichotomously (no vs. yes) and analyzed descriptively. The intensity of anxiety was evaluated using the Amsterdam Preoperative Anxiety and Information Scale (range 4–20). Associations between the intensity of anxiety and the resulting desire for support were analyzed using logistic regression. Receiver operating characteristic analyses were performed to identify anxiety levels that best predict desire for support. Results Among the 1000 (537 female; M (SD) 57 (18) years) subjects evaluated, 493 (318 (65 %) female) reported anxiety. Anxiety was associated with emotional distress in 320 (65 %) and desire for support in 291 (59 %) patients. Increased preoperative anxiety levels were associated with higher rates of desire for support (B= 0.270; odds ratio 1.31 [95 % CI 1.22–1.41]). An anxiety score > 9 was best to predict a desire for support (sensitivity 0.861, specificity 0.724). However, desire for support was even present in some patients with lowest anxiety scores (5 or 6). Conclusions All patients undergoing surgery should be screened for preoperative anxiety and the resulting desire for support to be able to determine who would welcome support. Anxiety scoring tools do not seem to be useful to identify these patients. By helping patients experience less preoperative anxiety, anesthesiologists may not only reduce patients’ emotional distress but also have a positive impact on postoperative outcome. Trial registration German Clinical Trials Register (DRKS 00013319, 23 November 2017).

Patients’ desires for anxiolytic premedication – an observational study in adults undergoing elective surgery

“…The sample size calculated for the survey was based upon the requirements for another study [ 5 ] that was also part of this survey. For that study [ 5 ] which focused on assessing the associations between preoperative anxiety and perceived emotional distress as well as desire for support, we calculated a sample size of 1000 patients since this would allow detecting even small correlations between anxiety and perceived emotional distress.…”

“…The sample included in this work has been used in a previous study [ 5 ]. However, none of the primary and secondary outcomes of the present study have been reported previously.…”

“…Most patients undergoing elective surgery under general anesthesia experience anxiety [ 1 – 4 ]. Preoperative anxiety is associated with a negative emotional impact and a desire for support [ 5 ]. Accordingly, anxiety has been cited most frequently as the worst aspect of the perioperative period in a survey carried out in more than 16,000 patients [ 6 ].…”

“…In the context of discussing the pros and cons of anxiolytic premedication in general (and not of a specific class of drugs used most commonly for this purpose), patient’s desire for anxiolytic premedication should be considered. Surprisingly, this important aspect has not been examined thoroughly so far despite the high importance of preoperative anxiety to patients [ 5 , 6 ]. Furthermore, little is known regarding the preferred time of taking anxiolytic medication during the preoperative period.…”

“…This study is part of a large cross-sectional questionnaire survey investigating various issues related to preoperative anxiety. The survey’s results with regard to associations between preoperative anxiety and resulting emotional distress and desire for support in coping with anxiety have been published very recently [ 5 ]. This paper focuses on important aspects of patient’s desire for anxiolytic medication prior to elective surgery and extends previous research by primarily examining: the ratio of patients who desire preoperative anxiolytic medication what time patients prefer to take premedication.…”