Preoperative Anxiety is Associated With Postoperative Complications in Vascular Surgery: A Cross‐Sectional Study

Abstract

Background Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery. Methods Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross‐sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia‐ and surgery‐related. Statistical analysis included multivariate linear logistic regression and point‐biserial correlation. Results Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39–86 years), 62.3% had previous surgery. High‐level anesthesia‐ and surgery‐related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high‐level anesthesia‐related anxiety were having no children (OR = 0.443, 95% CI: 0.239–0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043–5.045, p = 0.039), and time since diagnosis for ≥ 4 months (OR = 1.634, 95% CI: 1.023–5.983, p = 0.04). The female sex independently predicted high‐level surgery‐related preoperative anxiety (OR = 2.387, 95% CI: 1.432–3.979, p = 0.001). High‐level anesthesia‐related anxiety correlated with postoperative mental disorders (rpb = 0.193, p = 0.001) and pulmonary complications (rpb = 0.104, p = 0.042). Postoperative nausea (rpb = 0.111, p = 0.03) and postoperative mental disorders (rpb = 0.160, p = 0.002) correlated with high‐level surgery‐related preoperative anxiety. Conclusions Since preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.

Preoperative anxiety: An important, but neglected issue

“…(44) Also, a strong correlation was found between preoperative anxiety and subsequent dissatisfaction with surgical treatment. (47) Finally, our previous study (6) demonstrated that high-level preoperative anxiety is associated with severe postoperative complications (postoperative mental disorders, pulmonary complications, and postoperative nausea).…”

Designing a Perioperative Mind-Body Intervention for Peripheral Vascular Interventions

“…1,2 This anxiety is extremely common, even in individuals without any prior diagnosis of anxiety disorder, and has been associated with perioperative hemodynamic instability and, correspondingly, worse procedural outcomes. 1,3 Perioperative anxiety can be further compounded for patients with an anesthetic plan of procedural sedation and analgesia (PSA, also known as conscious sedation) as opposed to general anesthesia because they remain continuously aware of perioperative activity. 4,5 For patients undergoing peripheral vascular interventions (PVIs), PSA is often the preferred standard-of-care, because it avoids the cardiopulmonary stress of intubation, though patients need to be awake enough to comply with essential perioperative instructions from proceduralists such as holding the ipsilateral leg still and breath holds at certain intervals.…”

Does a 30-minute introductory visit to the operating room reduce patients’ anxiety before elective surgery? A prospective controlled observational study

“…Preoperative anxiety is associated with issues such as the need for higher doses of medication to induce anesthesia and postoperative analgesia, challenging intravenous access, and autonomic fluctuations. Furthermore, increased post-operative pain, nausea and vomiting, prolonged recovery, and increased risk of infection are associated with anxiety [ 6 ]. Various methods are used in different countries to reduce preoperative anxiety in patients.…”