Predictive Factors of Preoperative Anxiety in the Anesthesia Clinic: A Survey of 231 Surgical Candidates
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Abstract
Background: Despite the growing advancements of surgical and anesthetic techniques resulting in decreased morbidity and mortality, the period before surgery remains stressful for most patients. Considering the adverse effect of preoperative anxiety on anesthesia and surgery outcomes, we conducted this study to evaluate the level of anxiety in the anesthesia clinic among Iranian patients undergoing surgery and also to determine its associated factors.
Methods: This was a cross-sectional study performed on 231 patients admitted to the anesthesia clinic of Imam Khomeini hospital, Tehran, Iran. Data were collected by using a three-part questionnaire consisting of demographic data, clinical findings and the translated version of Spielberger state-trait anxiety inventory (STAI). Chi-square test and binary logistic regression model were performed for univariate and multivariate analysis, respectively. A p-value< 0.05 was considered statistically significant.
Results: The mean (SD) score for state and trait anxiety were 39.8 (13.4) and 36.5 (12.2), respectively. A significant association was seen between state anxiety and age, gender, occupation, level of education, marital status, patients’ awareness of type of anesthesia and patients’ awareness of anesthesia adverse events (p< 0.05). The most predictive factors for state anxiety were age, patients’ awareness of anesthesia adverse events and female gender, and for trait anxiety these factors were age, place of residence and female gender.
Conclusion: Screening for anxiety and identifying individuals vulnerable to preoperative anxiety (e.g. younger patients, females…) can help reduce undesirable surgery outcomes and their economic burden on the healthcare system.
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2. Williams JG JJ. Psychophysiological responses to anesthesia and operation. JAMA. 1968; 203(6):415-7.
3. Hughes BM, Howard S, James JE, Higgins NM. Individual differences in adaptation of cardiovascular responses to stress. Biol Psychol. 2011; 86(2):129-36.
4. Osborn TM, Sandler NA. The effects of preoperative anxiety on intravenous sedation. Anesth Prog. 2004; 51(2): 46–51.
5. Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg. 1999;89(6):1346-51.
6. Goldmann L OT, Levey AB. Hypnosis and daycase anaesthesia: a study to reduce pre-operative anxiety and intraoperative anaesthetic requirements. Anaesthesia. 1988; 43(6):466-9.
7. Kim W-S, Byeon G-J, Song B-J, Lee HJ. Availability of preoperative anxiety scale as a predictive factor for hemodynamic changes during induction of anesthesia. Korean J Anesthesiol. 2010; 58(4): 328–333.
8. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990; 73(2):308-27.
9. Vileikyte L. Stress and wound healing. Clin Dermatol. 2007; 25(1):49-55.
10. Christian LM, Graham JE, Padgett DA, Glaser R, Kiecolt-Glaser JK. Stress and wound healing. Neuroimmunomodulation. 2006; 13(5-6):337-46.
11. Linn BS, Linn MW, Klimas NG. Effects of psychophysical stress on surgical outcome. Psychosom Med. 1988; 50(3):230-44.
12. Boeke S, Jelicic M, Bonke B. Pre-operative anxiety variables as possible predictors of post-operative stay in hospital. Br J Clin Psychol. 1992; 31 (Pt 3):366-8.
13. Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology. Am Psychol. 1998; 53(11):1209-18.
14. Thomas T, Robinson C, Champion D, McKell M, Pell M. Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain. 1998; 75(2-3):177-85.
15. Janis IL. Psychological Stress: Psychoanalytic and behavioral studies of surgical patients.: New York: John Wiley & Sons; 1958. 439.
16. Debas HT, Laxminarayan R, Straus SE. Complementary and alternative medicine. Disease control priorities in developing countries. 2006;2.1281.
17. Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016; 94(3):201-9F.
18. Boker A, Brownell L, Donen N. The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety. Can J Anaesth. 2002 Oct;49(8):792-8.
19. Spielberger C., Gorsuch R., R. L. State trait anxiety inventory manual: Palo Alto, CA: Consulting Psychologists Press; 1970.
20. Matthias AT, Samarasekera DN. Preoperative anxiety in surgical patients-experience of a single unit. Acta Anaesthesiol Taiwan. 2012; 50(1):3-6.
21. Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani surgical patients. J Pak Med Assoc. 2009; 59(6):359-63.
22. Perks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol. 2009; 21(2):127-30.
23. Goktay F, Altan ZM, Talas A, Akpinar E, Ozdemir EO, Aytekin S. Anxiety Among Patients Undergoing Nail Surgery and Skin Punch Biopsy: Effects of Age, Gender, Educational Status, and Previous Experience. J Cutan Med Surg. 2016; 20(1):35-9.
24. Almalki MS, Hakami OAO, Al-Amri AM. Assessment of Preoperative Anxiety among Patients Undergoing Elective Surgery. The Egyptian Journal of Hospital Medicine. 2017; 69(5):2329-34.
25. Erkilic E, Kesimci E, Soykut C, Doger C, Gumus T, Kanbak O, et al. Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara. Patient Prefer Adherence. 2017; 11:291-6.
26. Ramin Ravangard PB, Asra Moradi, Mahdiehsadat Ahamdzadeh. Factors affecting the preoperative anxiety from the patients ' perspective. Daneshvarmed. 2016; 124:61-70.
27. Nazari Vanani R RMM, Rahimi-Madiseh M, Drees F. Evaluation of preoperative anxiety and stress, and ways to modify it, the patients in Kashani hospital operating room 2013. Journal of Clinical Nursing and Midwifery. 2013; 2(4):53-60.
28. Dehghan-nayeri NaA-H, M. Effects of progressive relaxation on anxiety and quality of life in female students: a non-randomized controlled trial. Complement Ther Med. 2011; 19(4):194-200.
29. Buehrer TW, Rosenthal R, Stierli P, Gurke L. Patients' Views on Regional Anesthesia for Elective Unilateral Carotid Endarterectomy—A Prospective Cohort Study. Ann Vasc Surg. 2015; 29(7):1392-9.
30. Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, et al. Risk factors for postoperative anxiety in adults. Anaesthesia. 2001; 56(8):720-8.
31. Masood Z, Haider J, Jawaid M, Alam Shams Nadeem. Preoperative anxiety in female patients: the issue needs to be addressed. 2009; 1(2):38-41.
32. Yilmaz M, Sezer H, Gürler H, Bekar M. Predictors of preoperative anxiety in surgical inpatients. J Clin Nurs. 2012; 21(7-8):956-64.
33. Karanci A, Dirik GJJopr. Predictors of pre-and postoperative anxiety in emergency surgery patients. J Psychosom Res. 2003; 55(4):363-9.
34. Basak F, Hasbahceci M, Guner S, Sisik A, Acar A, Yucel M, et al. Prediction of anxiety and depression in general surgery inpatients: A prospective cohort study of 200 consecutive patients. Int J Surg. 2015; 23(Pt A):18-22.
35. Woldegerima Y, Fitwi G, Yimer H, Hailekiros AJIJoSO. Prevalence and factors associated with preoperative anxiety among elective surgical patients at University of Gondar Hospital. Gondar, Northwest Ethiopia, 2017. A cross-sectional study. International Journal of Surgery Open. 2018; 10:21-9.
36. Aykent R, Kocamanoğlu İs, Üstün E, Tür A, Şahinoğlu H, The reasons and evaluation of preoperative anxiety: a comparison of APAIS and STAI scores. Turkiye Klinikleri J Anest Reanim. 2007; 5(1):7-13.
37. Uysal AI, Altiparmak B, Guner O. The Effect of an Informative Leaflet on Preoperative Anxiety and Patient's Knowledge of Anesthesia and Anxiety. Journal of Clinical and Analytical Medicine. 2017; 8(5):370-374.
38. Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg. 1996; 82(3):445-51.
39. Williams O A. Patient knowledge of operative care. J R Soc Med. 1993; 86(6):328.
40. Kiyohara LY, Kayano LK, Oliveira LM, Yamamoto MU, Inagaki MM, Ogawa NY, et al. Surgery information reduces anxiety in the pre-operative period. Rev Hosp Clin Fac Med Sao Paulo. 2004; 59(2):51-6.
41. Mavridou P, Dimitriou V, Manataki A, Arnaoutoglou E, Papadopoulos G. Patient’s anxiety and fear of anesthesia: effect of gender, age, education, and previous experience of anesthesia. A survey of 400 patients. J Anesth. 2013; 27(1):104-8.
42. Jawaid M, Mushtaq A, Mukhtar S, Khan Z. Preoperative anxiety before elective surgery. Neurosciences (Riyadh). 2007; 12(2):145-8.
2. Williams JG JJ. Psychophysiological responses to anesthesia and operation. JAMA. 1968; 203(6):415-7.
3. Hughes BM, Howard S, James JE, Higgins NM. Individual differences in adaptation of cardiovascular responses to stress. Biol Psychol. 2011; 86(2):129-36.
4. Osborn TM, Sandler NA. The effects of preoperative anxiety on intravenous sedation. Anesth Prog. 2004; 51(2): 46–51.
5. Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg. 1999;89(6):1346-51.
6. Goldmann L OT, Levey AB. Hypnosis and daycase anaesthesia: a study to reduce pre-operative anxiety and intraoperative anaesthetic requirements. Anaesthesia. 1988; 43(6):466-9.
7. Kim W-S, Byeon G-J, Song B-J, Lee HJ. Availability of preoperative anxiety scale as a predictive factor for hemodynamic changes during induction of anesthesia. Korean J Anesthesiol. 2010; 58(4): 328–333.
8. Weissman C. The metabolic response to stress: an overview and update. Anesthesiology. 1990; 73(2):308-27.
9. Vileikyte L. Stress and wound healing. Clin Dermatol. 2007; 25(1):49-55.
10. Christian LM, Graham JE, Padgett DA, Glaser R, Kiecolt-Glaser JK. Stress and wound healing. Neuroimmunomodulation. 2006; 13(5-6):337-46.
11. Linn BS, Linn MW, Klimas NG. Effects of psychophysical stress on surgical outcome. Psychosom Med. 1988; 50(3):230-44.
12. Boeke S, Jelicic M, Bonke B. Pre-operative anxiety variables as possible predictors of post-operative stay in hospital. Br J Clin Psychol. 1992; 31 (Pt 3):366-8.
13. Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology. Am Psychol. 1998; 53(11):1209-18.
14. Thomas T, Robinson C, Champion D, McKell M, Pell M. Prediction and assessment of the severity of post-operative pain and of satisfaction with management. Pain. 1998; 75(2-3):177-85.
15. Janis IL. Psychological Stress: Psychoanalytic and behavioral studies of surgical patients.: New York: John Wiley & Sons; 1958. 439.
16. Debas HT, Laxminarayan R, Straus SE. Complementary and alternative medicine. Disease control priorities in developing countries. 2006;2.1281.
17. Weiser TG, Haynes AB, Molina G, Lipsitz SR, Esquivel MM, Uribe-Leitz T, et al. Size and distribution of the global volume of surgery in 2012. Bull World Health Organ. 2016; 94(3):201-9F.
18. Boker A, Brownell L, Donen N. The Amsterdam preoperative anxiety and information scale provides a simple and reliable measure of preoperative anxiety. Can J Anaesth. 2002 Oct;49(8):792-8.
19. Spielberger C., Gorsuch R., R. L. State trait anxiety inventory manual: Palo Alto, CA: Consulting Psychologists Press; 1970.
20. Matthias AT, Samarasekera DN. Preoperative anxiety in surgical patients-experience of a single unit. Acta Anaesthesiol Taiwan. 2012; 50(1):3-6.
21. Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani surgical patients. J Pak Med Assoc. 2009; 59(6):359-63.
22. Perks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol. 2009; 21(2):127-30.
23. Goktay F, Altan ZM, Talas A, Akpinar E, Ozdemir EO, Aytekin S. Anxiety Among Patients Undergoing Nail Surgery and Skin Punch Biopsy: Effects of Age, Gender, Educational Status, and Previous Experience. J Cutan Med Surg. 2016; 20(1):35-9.
24. Almalki MS, Hakami OAO, Al-Amri AM. Assessment of Preoperative Anxiety among Patients Undergoing Elective Surgery. The Egyptian Journal of Hospital Medicine. 2017; 69(5):2329-34.
25. Erkilic E, Kesimci E, Soykut C, Doger C, Gumus T, Kanbak O, et al. Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara. Patient Prefer Adherence. 2017; 11:291-6.
26. Ramin Ravangard PB, Asra Moradi, Mahdiehsadat Ahamdzadeh. Factors affecting the preoperative anxiety from the patients ' perspective. Daneshvarmed. 2016; 124:61-70.
27. Nazari Vanani R RMM, Rahimi-Madiseh M, Drees F. Evaluation of preoperative anxiety and stress, and ways to modify it, the patients in Kashani hospital operating room 2013. Journal of Clinical Nursing and Midwifery. 2013; 2(4):53-60.
28. Dehghan-nayeri NaA-H, M. Effects of progressive relaxation on anxiety and quality of life in female students: a non-randomized controlled trial. Complement Ther Med. 2011; 19(4):194-200.
29. Buehrer TW, Rosenthal R, Stierli P, Gurke L. Patients' Views on Regional Anesthesia for Elective Unilateral Carotid Endarterectomy—A Prospective Cohort Study. Ann Vasc Surg. 2015; 29(7):1392-9.
30. Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, et al. Risk factors for postoperative anxiety in adults. Anaesthesia. 2001; 56(8):720-8.
31. Masood Z, Haider J, Jawaid M, Alam Shams Nadeem. Preoperative anxiety in female patients: the issue needs to be addressed. 2009; 1(2):38-41.
32. Yilmaz M, Sezer H, Gürler H, Bekar M. Predictors of preoperative anxiety in surgical inpatients. J Clin Nurs. 2012; 21(7-8):956-64.
33. Karanci A, Dirik GJJopr. Predictors of pre-and postoperative anxiety in emergency surgery patients. J Psychosom Res. 2003; 55(4):363-9.
34. Basak F, Hasbahceci M, Guner S, Sisik A, Acar A, Yucel M, et al. Prediction of anxiety and depression in general surgery inpatients: A prospective cohort study of 200 consecutive patients. Int J Surg. 2015; 23(Pt A):18-22.
35. Woldegerima Y, Fitwi G, Yimer H, Hailekiros AJIJoSO. Prevalence and factors associated with preoperative anxiety among elective surgical patients at University of Gondar Hospital. Gondar, Northwest Ethiopia, 2017. A cross-sectional study. International Journal of Surgery Open. 2018; 10:21-9.
36. Aykent R, Kocamanoğlu İs, Üstün E, Tür A, Şahinoğlu H, The reasons and evaluation of preoperative anxiety: a comparison of APAIS and STAI scores. Turkiye Klinikleri J Anest Reanim. 2007; 5(1):7-13.
37. Uysal AI, Altiparmak B, Guner O. The Effect of an Informative Leaflet on Preoperative Anxiety and Patient's Knowledge of Anesthesia and Anxiety. Journal of Clinical and Analytical Medicine. 2017; 8(5):370-374.
38. Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg. 1996; 82(3):445-51.
39. Williams O A. Patient knowledge of operative care. J R Soc Med. 1993; 86(6):328.
40. Kiyohara LY, Kayano LK, Oliveira LM, Yamamoto MU, Inagaki MM, Ogawa NY, et al. Surgery information reduces anxiety in the pre-operative period. Rev Hosp Clin Fac Med Sao Paulo. 2004; 59(2):51-6.
41. Mavridou P, Dimitriou V, Manataki A, Arnaoutoglou E, Papadopoulos G. Patient’s anxiety and fear of anesthesia: effect of gender, age, education, and previous experience of anesthesia. A survey of 400 patients. J Anesth. 2013; 27(1):104-8.
42. Jawaid M, Mushtaq A, Mukhtar S, Khan Z. Preoperative anxiety before elective surgery. Neurosciences (Riyadh). 2007; 12(2):145-8.
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| Issue | Vol 5 No 4 (2019): Autumn |
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| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v5i4.1452 | |
| Keywords | ||
| Anesthesia Preoperative anxiety Spielberger questionnaire Spielberger state-trait anxiety inventory (STAI) Surgery | ||
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How to Cite
1.
Khalili N, Karvandian K, Eftekhar Ardebili H, Eftekhar N, Nabavian O. Predictive Factors of Preoperative Anxiety in the Anesthesia Clinic: A Survey of 231 Surgical Candidates. Arch Anesth & Crit Care. 2019;5(4):122-127.
