The effect of a preanaesthesia clinic consultation on adult patient anxiety at a tertiary hospital in Kenya: a cohort study

Abstract

Background: Preoperative anxiety is a common perioperative complication seen in approximately 11-80% of adults undergoing surgery. One of the goals of the preanaesthesia clinic is to allay anxiety. A preanaesthesia clinic evaluation has been shown to reduce anxiety however current studies on anxiety and the preanaesthesia clinic have not quantified this reduction. Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward. Methods: Fifty one adult patients with 28 patients in anaesthesia clinic (AC) group and 23 in the ward (W) group were sequentially recruited from both the surgical, gynaecology and antenatal outpatient clinics and the wards. The patient's State Trait Anxiety Index (STAI) was taken once the patient was booked for theatre. The patients then had a preanaesthesia evaluation either in the preanaesthesia outpatient clinic (PAC) or in the wards. Another STAI score was taken in the preoperative area in theatre on the day of surgery. The difference in the change of STAI scores in both groups was then analysed. Results: Fifty one adult patients were recruited with 28 in the AC group and 23 in the W group. The majority of patients were female (n=38). Statistically significant difference was seen in the reduction of the anxiety scores between the clinic group 2.143 (C.I=1.384-2.902) and ward group 0.74(C.I=0.17-1.31) with a p value=0.0051.There was also significant difference in reduction in anxiety scores within ward group in the patients with no prior anaesthetic experience having a greater reduction than those with prior anaesthetic experience. There were no other significant differences between the two groups. Conclusion: Patients evaluated in the anaesthesia clinic had a greater reduction in their anxiety but it was not as much as hypothesised which may be due to the multi-factorial nature of preoperative anxiety. A larger multicenter study is recommended to increase generalizability to the population.

The effect of pre-anaesthetic assessment clinic: a systematic review of randomised and non-randomised prospective controlled studies

“…There was one controlled before-after study. [34] The other six studies had control groups but no baseline assessments, only assessments following PAC implementation. There were three 2-group non-parallel after-only studies,[29,30,32] and three 2-group parallel after-only studies [28], where one had a matched control group[31] and one had three follow-up assessments of one arm.…”

“…However, the terminology used for PACs varied; they served different surgical specialities, and the pre-anaesthesia consultation was conducted from ≥48 h to ≤3 months before the surgery. Three were implemented in a university hospital,[31,33,34] one in a teaching hospital,[30] one in a medical centre,[32] and one in a general hospital[29] (one study did not specify the context). [28] The person conducting the pre-anaesthesia consultation also varied: in five studies, it was the anaesthesiologists,[28-31,33] in the other studies it was (also) the orthopaedic senior house officer,[29] the consultant or resident,[34] or the physician.…”

“…Three were implemented in a university hospital,[31,33,34] one in a teaching hospital,[30] one in a medical centre,[32] and one in a general hospital[29] (one study did not specify the context). [28] The person conducting the pre-anaesthesia consultation also varied: in five studies, it was the anaesthesiologists,[28-31,33] in the other studies it was (also) the orthopaedic senior house officer,[29] the consultant or resident,[34] or the physician. [32] In three studies, nurses were part of the team assessing the patients.…”

“…11583). [28,30-32,34] There were more females than males both in the intervention (4345 vs. 4134) and the control groups (7784 vs. 7449). Five studies reported data for age showing that all the patients were over 20 years old and grouped within the American Society of Anesthesiology (ASA) category.…”

“…Five studies reported data for age showing that all the patients were over 20 years old and grouped within the American Society of Anesthesiology (ASA) category. [28,30-32,34]…”