Triggers of Preoperative Anxiety in Patients Undergoing Mohs Micrographic Surgery

Kruchevsky, Dani; Hirth, Jacob; Capucha, Tal; Ullmann, Yehuda; Ramon, Yitzchak

doi:10.1097/dss.0000000000002857

Cited by 5 publications

(8 citation statements)

References 5 publications

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“…Thus, routinely recommending consultations may not be the best approach for improving anxiety outcomes. Current research supports that a history of prior MMS decreases patient anxiety 1,8 ; however, these research findings showed no significant relationship between prior skin cancer removal and self-reported patient anxiety. Although a previous study found that layers removed did not influence patient anxiety, 11 these results, in contrast, demonstrate a significant relationship between increased layer removal and higher patient anxiety.…”

Section: Discussionmentioning

confidence: 58%

“…The authors also corroborate previous research findings concerning the influence of age and sex on MMS patient anxiety. 8 Although existing research is divided regarding the efficacy of pre-MMS consultation for anxiety reduction, 9,10 these findings suggest that patient-reported and HCP-perceived anxiety were not significantly affected by in-person pre-MMS consultation with the surgeon. Thus, routinely recommending consultations may not be the best approach for improving anxiety outcomes.…”

Section: Discussionmentioning

confidence: 96%

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Analysis of Factors Contributing to Perioperative Mohs Micrographic Surgery Anxiety: Patient Survey Study at an Academic Center

et al. 2022

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BACKGROUNDHigh perioperative patient anxiety is predictive of worse postoperative pain and quality of life. Several Mohs micrographic surgery (MMS) patient characteristics influence anxiety; however, the contributions of certain factors remain uncertain.OBJECTIVEInvestigate factors influencing perioperative MMS patient anxiety, especially those with debated impact or unclear data.METHODSThe authors surveyed 145 adult patients receiving MMS performed by a single MMS surgeon from 2018 to 2020. Patients self-reported demographics, history, and 10-point visual analog scale anxiety assessments at multiple stages. Health care provider (HCP)–perceived anxiety assessments were queried. A stepwise multiple regression modeling approach was used to explore potential factors.RESULTSYounger age, female sex, and a self-reported history of anxiety confirmed by prior HCP diagnosis were significant predictors of pre-MMS anxiety. Postoperative anxiety increased with more layers removed and higher pre-MMS anxiety. HCP–perceived patient anxiety increased with younger patient age, more layers removed, prior skin cancer removal, and HCP-perceived pre-MMS patient anxiety.CONCLUSIONAnxiety-reducing interventions should target young female patients with a history of HCP-diagnosed anxiety, and patients with more layers removed. Prior skin cancer removal is associated with increased HCP-perceived intraoperative patient anxiety; however, it is not significant for patient-reported anxiety. Pre-MMS consultation may not be effective for anxiety reduction.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 96%

Analysis of Factors Contributing to Perioperative Mohs Micrographic Surgery Anxiety: Patient Survey Study at an Academic Center

et al. 2022

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“…First, providers should be able to anticipate if their patients are more likely to experience anxiety. Specific factors responsible for preoperative anxiety in Mohs Micrographic Surgery (MMS) patients are female gender, younger age, lack of chronic diseases, first‐time MMS patients, self‐reported history of anxiety, increased Mohs stage removal, centrally located facial tumors, a prior biopsy or excision with positive margins, and anticipated closure by a flap or skin graft 4,5 . Additionally, Wang et al 1 .…”

Section: Introductionmentioning

confidence: 99%

“…Specific factors responsible for preoperative anxiety in Mohs Micrographic Surgery (MMS) patients are female gender, younger age, lack of chronic diseases, first-time MMS patients, self-reported history of anxiety, increased Mohs stage removal, centrally located facial tumors, a prior biopsy or excision with positive margins, and anticipated closure by a flap or skin graft. 4,5 Additionally, Wang et al 1 found that a more significant surgical undertaking and a history of cancer are two factors associated with higher levels of preoperative anxiety. These factors should be taken into consideration when determining if an anxiety-reducing intervention is needed.…”

Section: Introductionmentioning

confidence: 99%

A practical guide to reducing preoperative and intraoperative patient anxiety in dermatologic surgery

Yousif,

Alkhouri,

St. Claire

et al. 2023

Int J Dermatology

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BackgroundDermatologists perform a variety of procedures including excisions, biopsies, and other minor surgical procedures. Patients can experience anxiety in anticipation of their surgeries or may develop anxiety during the procedure. Since most dermatologic procedures occur with the patient awake and alert, the physician can offer comforting methods to alleviate some of that anxiety.AimsWe wanted to provide a review of available methods that dermatologists can use to reduce patient anxiety.Materials & MethodsIn this paper, we review the current literature on methods that can be used in dermatology offices to reduce overall patient anxiety levels.ResultsIn the preoperative stage, providers can offer educational content to explain the procedure to their patients. Whether it be through telephone calls, educational videos, or utilization of visual models, educating the patient regarding their procedure may reduce their anxiety. Intraoperatively, there are multiple methods that can be used such as music, guided imagery, coloring books, medications, hypnosis, and distraction techniques.Discussion & ConclusionThere is a variety of approaches that can be easily implemented in the office and can help in reducing the anxiety of the patients to allow for a pleasant patient experience and an overall satisfactory procedure outcome.

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“…5,6 If iMMS is unanticipated, patients may experience anxiety because they unexpectedly await scheduling of additional surgery. 2,4,7,8…”

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confidence: 99%

Anticipated Versus Unanticipated Incomplete Mohs Micrographic Surgery for Keratinocyte Carcinomas: Impact on Treatment Delays and Final Margin Status

Lin,

Deitermann,

Lubeck

et al. 2023

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BACKGROUND Mohs micrographic surgery may be discontinued with positive margins as an anticipated strategy for multidisciplinary care or as an unanticipated occurrence. Management of primary tumors has not been compared after anticipated versus unanticipated incomplete Mohs micrographic surgery (iMMS). OBJECTIVE To compare rates and timing of adjuvant surgery after iMMS and final margin status when iMMS is anticipated versus unanticipated. Secondary outcomes were preoperative and intraoperative clinicopathologic factors associated with iMMS. METHODS Cases of iMMS of keratinocyte carcinomas at a tertiary academic center between 2005 and 2022 were classified as anticipated (preoperative assembly of multidisciplinary teams) or unanticipated (ad hoc management of positive margins). Rate, timing, and final margin status of adjuvant surgery was compared between anticipated and unanticipated iMMS cohorts using χ2/Fisher exact test for categorical variables and t-test for continuous variables. RESULTS Of 127 iMMS cases, 51.2% (65/127) were anticipated. Anticipated iMMS cases were more likely to undergo additional resection (98.5% vs 72.6%, p < .001), with fewer delays (3.9 vs 13.2 days, p < .001) and higher rates of final margin clearance (84.6% vs 59.7%, p < .001). CONCLUSION When iMMS is anticipated as part of multidisciplinary care, patients are more likely to undergo additional resection, with fewer delays to next surgery and higher final margin clearance rates.

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Triggers of Preoperative Anxiety in Patients Undergoing Mohs Micrographic Surgery

Cited by 5 publications

References 5 publications

Analysis of Factors Contributing to Perioperative Mohs Micrographic Surgery Anxiety: Patient Survey Study at an Academic Center

Analysis of Factors Contributing to Perioperative Mohs Micrographic Surgery Anxiety: Patient Survey Study at an Academic Center

A practical guide to reducing preoperative and intraoperative patient anxiety in dermatologic surgery

Anticipated Versus Unanticipated Incomplete Mohs Micrographic Surgery for Keratinocyte Carcinomas: Impact on Treatment Delays and Final Margin Status

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