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

Designing a Culturally Adapted Perioperative Mental Health Intervention for Older Black Male Surgical Patients: A Community-Based Participatory Study

OBJECTIVES

Anxiety and depression are common in older surgical patients and impair recovery. Black patients, particularly men, face compounded disparities in both mental health care and surgical outcomes, with distinct gender-specific needs. This study examined perioperative mental health stressors and care needs among older Black male surgical patients to inform the development of a culturally tailored intervention.

DESIGN, SETTING, AND PARTICIPANTS

Sixteen focus groups were conducted with 15 Black male patients, aged ≥50 who had undergone surgery at a large academic medical center. Discussions explored perioperative experiences, mental health challenges, and preferences for a culturally responsive wellness program. Inductive thematic analysis was used. A community engagement studio provided additional feedback on proposed intervention components.

RESULTS

Participants reported significant emotional distress, especially anxiety and fear, magnified by cultural stigma, mistrust of the medical system, and reluctance to use medication. Common coping strategies included faith, family, and peer connections. Participants strongly endorsed the need for patient-centered, culturally sensitive support. Recommended intervention components included psychoeducation, psychotherapy, peer support, and medication counseling, with optional components incorporating family or faith-based support. Flexibility in delivery and trust-building were viewed as essential.

CONCLUSION

Mental health is a critical yet under-addressed component of surgical recovery for older Black males. This study demonstrates the urgency of addressing perioperative anxiety and distress through culturally tailored, trust-centered care. An integrated intervention that combines psychoeducation, psychotherapy, and peer support may reduce stigma, strengthen mental health engagement, and improve surgical outcomes and long-term well-being.

Relationships between anxiety, depression and wound healing outcomes in adults: A systematic review and meta-analysis

OBJECTIVES

To examine whether there is a relationship between anxiety and/or depression and wound healing.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Searches were conducted on PsycINFO, MEDLINE, EMBASE, CINAHL and Web of Science on the 06-March-2023.

METHODS

Eligible studies explored the effects of anxiety and/or depression on wound healing in adults. Healing outcomes included time to heal and complication rates. Anxiety and depression outcomes were considered separately.

RESULTS

Fifty-five studies were included in the narrative synthesis (26,612,809 participants), and 26 studies in the meta-analysis. Studies utilised a range of observational and experimental designs. Wounds included in the review were: surgical, ulcer, burn and experimental wounds. The narrative synthesis gave mixed results, with some studies noting positive associations between increased anxiety or depression and wound healing, while others did not find an association. Results from the meta-analysis found no significant effect of anxiety on wound healing outcomes. However, depression was associated with significantly higher odds of delayed wound healing, OR = 2.10, [1.02, 4.33]; higher risk of wound complications, RR = 1.30, [1.11, 1.53] and increased risk of wound infection RR = 1.25, [1.09, 1.44].

CONCLUSION

These findings suggest depression negatively impacts wound healing. There is less evidence for an association with anxiety, but this may be due to less research in this area. Future studies should explore the mechanism of associations between depression and wound healing to inform clinical interventions.

Play dough or balloon blowing? A clinical trial comparing creative interventions for reducing preoperative anxiety in children aged 4-8 years

BACKGROUND

Preoperative anxiety is a significant concern for pediatric patients undergoing surgery, often leading to adverse physiological, emotional, and postoperative outcomes. Traditional pharmacological approaches, while effective, are associated with side effects, underscoring the need for age-appropriate non-pharmacological interventions. This study aimed to compare the effectiveness of play dough (PD) activities and balloon blowing (BB) in reducing preoperative anxiety in children.

METHODS

This randomized controlled trial included 90 children aged 4-8 years, a developmental stage characterized by responsiveness to play-based interventions, scheduled for elective surgeries at Besat Hospital, Hamedan, Iran, between November 2023 and January 2025. Participants were randomized into three groups: PD, BB, and Control (standard care with midazolam). Anxiety levels were assessed at baseline (T0), immediately before entering the operating room (T1), and during anesthesia induction (T2) using the Modified Yale Preoperative Anxiety Scale (m-YPAS) and the Visual Analog Scale for Anxiety (VAS-A). Each intervention was administered for 15 min under direct supervision by a trained researcher. Statistical analysis included ANOVA for continuous variables and chi-square tests for categorical variables. Post hoc comparisons were performed using Tukey's method.

RESULTS

At T1 and T2, children in the PD and BB groups exhibited significantly lower anxiety levels compared to the Control group (P < 0.001). For m-YPAS scores at T1, the PD group mean 36.05 ± 4.28, and the BB group 35.15 ± 2.94, compared to 54.55 ± 4.05 in the Control group. Similar trends were noted at T2. VAS-A analysis further supported these findings, with the PD and BB groups showing higher proportions of mild anxiety compared to the Control group. No significant differences were detected between the PD and BB groups, indicating that both interventions were comparably effective.

CONCLUSIONS

PD and BB are effective non-pharmacological interventions for reducing preoperative anxiety in children. These cost-effective, engaging techniques offer safe alternatives to pharmacological treatments and promote emotional well-being. The findings support integrating age-appropriate, creative, play-based strategies into pediatric surgical care, emphasizing their potential to enhance the preoperative experience and improve outcomes. Future research should investigate long-term impacts, applicability across diverse populations, and comparative efficacy in various clinical settings.

TRIAL REGISTRATION

Registered in the Iranian registry of clinical trials ( https://irct.behdasht.gov.ir ) in 19/11/2023 with the following code: IRCT20230514058183N1.

Pilot study protocol for a novel perioperative mind-body intervention for peripheral vascular interventions

Background

A novel mind-body intervention (MBI) targeting vascular surgery patients undergoing peripheral vascular interventions (PVIs) under procedural sedation and analgesia (PSA) was recently developed, but has yet to be clinically tested. An exploratory randomized controlled trial is planned to test the novel intervention in patients undergoing PVIs under PSA.

Methods

Patients undergoing PVIs under PSA by vascular surgeons across four hospitals in Massachusetts and New Hampshire will be screened for enrollment. Exclusion criteria include urgent or emergent procedures, prior ipsilateral lower extremity amputations (including digit amputations) and non-English speakers. 30 patients will be enrolled and randomized 1:1 to either a perioperative MBI on the day of surgery (n = 15), or a standard of care control (n = 15). There would be no restriction on anesthesia practice, and collected data will include perioperative pain and sedation requirements and qualitative feedback from both the patients and perioperative staff.

Conclusions

This protocol delineates a pilot randomized controlled trial to test the feasibility and acceptability of a novel perioperative MBI for patients undergoing PVIs under PSA.

The impact of compassion-based interventions on perioperative anxiety and depression: A systematic review and meta-analysis

BACKGROUND

The perioperative period can be a stressful time for many patients. Concerns for the procedure or fearing potential complications contribute to perioperative anxiety and depression, which significantly impact patient wellbeing and recovery. Understanding the psychological impact of the perioperative period can inform individualized care focused on each patient's unique stressors. Compassion-based interventions are limited but have shown benefits in non-surgical healthcare settings, and can provide support by prioritizing empathy and understanding in the perioperative period. This review evaluates the impact of compassion-based interventions on anxiety and depression among adult surgical patients.

METHODS

A systematic review of 25 randomized controlled trials was conducted with a meta-analysis of 14 studies for anxiety and 9 studies for depression that provided sufficient information.

RESULTS

The included studies tested compassion-based interventions that focused on enhanced communication, emotional support, and individualized attention from healthcare professionals. In 72 % of the studies, the interventions decreased anxiety and depression, compared to control groups. These interventions improved health-related outcomes such patient satisfaction and postoperative complications. The meta-analysis indicated a large effect of the compassion-based interventions for anxiety (g = -0.95) and depressive symptoms (g = -0.82). The findings were consistent among various surgeries and patient populations.

LIMITATIONS

Many of the included studies lacked clarity in their methods and only 14 studies provided sufficient information for the meta-analysis.

CONCLUSIONS

Given the growing evidence suggesting that compassion-based psychological interventions are feasible and applicable in the perioperative setting, their inclusion in routine care could reduce depression and anxiety around surgery and improve patient outcomes and experiences.

Designing a Perioperative Mind-Body Intervention for Peripheral Vascular Interventions

Background

Peripheral vascular interventions (PVIs) performed under procedural sedation and analgesia (PSA) can be associated with anxiety and poor compliance with patient instructions during surgery. Mind-body interventions (MBIs) such as meditation have demonstrated the potential to decrease perioperative anxiety, though this area is understudied, and no tailored interventions have been developed for the vascular surgical patient population.

Objectives

We aimed to design a perioperative MBI that specifically targeted vascular surgical patients undergoing PVIs under PSA. We sought to perform this in a scientifically rigorous, multi-disciplinary collaborative manner.

Methods

Following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, we designed (Phase 1a) and then refined (Phase 1b) a MBI for patients undergoing PVIs under PSA to decrease perioperative anxiety and sedation and facilitate patient intraoperative compliance. Phase 1a involved a literature review, informal information gathering and synthesis, and drafting a preliminary protocol for a perioperative MBI. Phase 1b involved assembling a multi-disciplinary expert panel of perioperative and mind-body clinicians and researchers to improve the MBI using an iterative, modified Delphi approach.

Results

The modified Delphi process was completed, and a consensus was reached after three iterations. The resulting MBI consisted of two seven-minute preoperative guided meditations on the day of surgery, including diaphragmatic breathing, body scans, and guided imagery emphasizing awareness of the ipsilateral leg where the vascular surgery was performed. A document delineating the integration of the MBI into the operating room workflow was produced, including details regarding the intervention's timing, duration, and modality.

Conclusion

Using a multi-specialty expert panel, we designed a novel MBI in the form of a guided meditation with elements of mindfulness and guided imagery to decrease anxiety and increase intraoperative compliance for patients undergoing PVIs under PSA. A prospective pilot study is being planned to test the program's feasibility.

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

BACKGROUND

Patients scheduled for elective surgery typically suffer from preoperative anxiety related to the unknown environment and unclear expectations. We hypothesized that a virtual or in-person introductory visit to the operating room one day before surgery may decrease the extent of preoperative anxiety by familiarizing patients and their families with the operating room environment. So, this study aimed to evaluate the impact of operating room visits, conducted both in-person and virtual reality, on patients' preoperative anxiety.

METHODS

This prospеctivе controllеd obsеrvational study еxaminеd patiеnts who wеrе candidatеs for gеnеral surgеry in a tеaching hospital in Iran. All patiеnts agеd bеtwееn 18-60 yеars, who wеrе undеrgoing gеnеral surgеry bеtwееn April and Sеptеmbеr 2022 and had prеopеrativе anxiеty basеd on thе Spiеlbеrgеr quеstionnairе, wеrе sеlеctеd. Patients who had emergency surgery or were taking anti-anxiety drugs were excluded from the study. Patiеnts wеrе thеn randomly assignеd to thе in-pеrson visit, virtual rеality visit, and control groups. In thе in-pеrson group, individuals visitеd thе opеrating room for 30 minutеs on thе day bеforе surgеry. In contrast, in thе virtual rеality group, visits wеrе conductеd via a 'livе' virtual vidеo tour of thе opеrating room for thе samе duration on thе day bеforе surgеry. The control group received routine care such as prе-surgеry hospitalization and mеdication. All participants completed the Spielberger questionnaire before the intervention (the day before surgery) and again two hours before surgery. Data were analyzed using variance analysis, t-tests, and Chi-square tests in SPSS 22 software.

RESULTS

Wе idеntifiеd 105 patiеnts undеrgoing gеnеral surgеry who wеrе dividеd into thrее groups of 35 pеoplе еach. Thе rеsults showеd that, bеforе thе intеrvеntion, thеrе wеrе no statistically significant diffеrеncеs among thе thrее groups in tеrms of dеmographic data and prеopеrativе anxiеty (p > 0.05). Aftеr thе intеrvеntion, thе mеan scorеs of prеopеrativе anxiеty in thе in-pеrson visit, virtual rеality visit, and control groups wеrе 52.82 ± 4.51, 54.48 ± 5.04, and 53.42 ± 4.62, rеspеctivеly, with no significant statistical diffеrеncе (p = 0.33). Furthermore, there was no significant difference in preoperative anxiety scores before and after the intervention in the in-person visit (p = 0.13), virtual reality visit (p = 0.10), and control (p = 0.33) groups.

CONCLUSION

A 30-minute visit to familiarize patients with the operating room environment, equipment, and staff, whether conducted in-person or virtually, does not significantly affect patients' preoperative anxiety or reduce their anxiety levels.

Effects of successful parathyroidectomy on neuropsychological and cognitive status in patients with asymptomatic primary hyperparathyroidism

PURPOSE

Besides typical clinical symptoms, primary hyperparathyroidism (pHPT) is associated with impaired quality of life and cognitive status. The aim of this study was to evaluate the quality of life and cognitive impairment in patients with pHPT, before and after parathyroidectomy.

METHODS

We conducted a panel study, which included asymptomatic pHPT patients scheduled for parathyroidectomy. Besides demographic and clinical data, patients' quality of life and cognitive capacity were recorded before, 1 month, and 6 months following parathyroidectomy using the Short Form 36 questionnaire (RAND-36), Beck Depression Inventory (BDI), Depression Anxiety Stress Scales (DASS), Mini-Mental State Examination (MMSE), and Symptom Check List 90-revised version (SCL90R).

RESULTS

During a 2-year follow-up, 101 patients entered the study (88 women), with an average age of 60.7 years. The Global score of RAND-36 test ameliorated by almost 50% 6 months after parathyroidectomy. The most sustained subscores of the RAND-36 test were role functioning/physical and health change, with an improvement of more than 125%. According to the BDI, DASS depression subscore, and SCL90R depression subscore, the extent of depressive symptoms reduction was approximately 60% 6 months postoperatively. The level of anxiety was reduced by 62.4%, measured by both the DASS and SCL90R anxiety subscores. The stress level was almost halved according to the DASS stress subscore (from 10.7 to 5.6 points). The results of the MMSE test showed a significant improvement postoperatively, for 1.2 points (4.4%). A worse preoperative score of each tool was related to the higher magnitude of improvement 6 months after parathyroidectomy.

CONCLUSION

A considerable number of pHPT patients, even without other typical symptoms, show signs of impaired quality of life and neurocognitive status preoperatively. After a successful parathyroidectomy, there is an improvement in quality of life, declined levels of depression, anxiety, and stress, as well as amelioration of cognitive status. Patients with more impaired quality of life and pronounced neurocognitive symptoms may expect more benefits from the surgery.