Association of preoperative anxiety and depression symptoms with postoperative complications of cardiac surgeries

Impact of psycho-educational interventions on patients undergoing Coronary Artery Bypass Grafting Surgery

BACKGROUND

Postoperative period of Coronary Artery Bypass Grafting can be challenging, with physical and psychological problems and symptoms. We conducted this study to explore the effect of a psycho-educational intervention on anxiety, pain and physiological parameters among Coronary Artery Bypass Grafting surgery patients.

METHODS

A randomized clinical trial design included one experimental and control group. Data were collected from 56 candidates for coronary artery bypass surgery (n = 28) in the intervention and (n = 28) in the usual care groups. Settings were the cardiac centers of the three teaching, specialty, and subspecialty Nemazee, Faghihi, and Al-Zahra hospitals affiliated with Shiraz University of Medical Sciences (SUMS). The data were collected using a demographic information form, the Short-Form McGill Pain Questionnaire, the Spielberger State-Trait Anxiety Inventory, and the physiological parameters form (systolic and diastolic blood pressure, heart rate, respiratory rate, and peripheral oxygen saturation). Psycho-educational interventions were performed individually through face-to-face sessions. All tests were two-tailed, and the statistical level was considered 0.05.

RESULTS

The mean scores of state anxiety and pain decreased significantly after the intervention (p < 0.05). Also, psycho-educational interventions affected peripheral oxygen saturation percentage, and breathing rate mean scores (P < 0.05). But, they did not affect the blood pressure and pulse rate (P > 0.05). At the same time, there was no significant difference in the control group.

CONCLUSION

This study indicated that the pre-operative psycho-educational interventions facilitated intrapersonal caring, reduce state anxiety, relieve pain and stabilize physiological parameters such as peripheral oxygen saturation percentage and breathing rate after surgery among Coronary Artery Bypass Grafting surgery patients. Hence, this intervention is recommended for developing care programs in same population.

TRIAL REGISTRATION

https://www.irct.ir/trial/55652 : IRCT20090908002432N8 (2021-09-17).

The Effects of Acupressure on Preoperative Anxiety, Postoperative Pain, and Nausea and Vomiting in Otolaryngology Patients

PURPOSE

Surgical patients frequently experience symptoms such as preoperative anxiety, postoperative pain, and nausea and vomiting. The aim of this study was to determine the effects of acupressure on preoperative anxiety, postoperative pain, and nausea and vomiting in otolaryngology patients.

DESIGN

The study was designed as a prospective, assessor-blinded, parallel, 2-armed (1:1), randomized controlled trial.

METHODS

The sample of this study consisted of 60 otolaryngology patients. Patients were assigned to the acupressure (n = 30) or control (n = 30) groups (1:1) through randomization. During the preoperative period, participants in the acupressure group received a 15-minute treatment involving pressure applied to the HT7, LI4, and EX-HN3 points. No intervention was administered to participants in the control group. Preoperative anxiety levels were evaluated using the State Anxiety Scale both before and 15 minutes after the acupressure application. Postoperative pain was assessed using the Numeric Pain Rating Scale at 4 hours postoperatively, at 10:00 p.m., at 08:00 a.m., and upon discharge. Postoperative nausea and vomiting were assessed at discharge using the Rhodes Index of Nausea, Vomiting, and Retching.

FINDINGS

Although the preoperative anxiety of the control group increased in the operating room waiting area, that of the acupressure group decreased significantly (P = .033). The postoperative pain severity levels of the 2 groups were similar at the fourth hour after surgery and at 10:00 p.m. (P > .05), whereas they were significantly lower at 08:00 a.m. (P = .04) and discharge (P = .048) in the acupressure group. No significant difference was found between the groups in postoperative nausea and vomiting symptoms (P > .05).

CONCLUSIONS

Acupressure was effective in reducing the severity of preoperative anxiety and postoperative pain in otolaryngology patients, but the same effect was not observed in postoperative nausea and vomiting.

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.

Psychiatric Diagnoses Are Associated With Postoperative Disparities in Patients Undergoing Major Colorectal Operations

BACKGROUND

Over 50% of hospitalized patients have comorbid psychiatric diagnoses, resulting in increased risk of morbidity such as longer lengths of stay, worse health-related quality of life, and increased mortality. However, data regarding colorectal surgery postoperative outcomes in patients with psychiatric diagnoses (PD) are limited.

METHODS

We queried a single institution's National Surgical Quality Improvement Program from 2013-2019 for major colorectal procedures. Postsurgical outcomes for patients with and without PD were compared. Primary outcomes were prolonged length of stay (pLOS) and 30-day readmission.

RESULTS

From a total of 1447 patients, 402 (27.8%) had PD. PD had more smokers (20.9% vs 15%) and higher mean body mass index (29.1 kg/m2 vs 28.2 kg/m2). Bivariate outcomes showed more surgical site infections (SSI) (10.2% vs 6.12%), reoperation (9.45% vs 6.35%), and pLOS (34.8% vs 29.0%) (all P values <.05) in the PD group. On multivariate analysis, PD had higher likelihood of reoperation (OR 1.53, 95% CI: [1.02-2.80]) and SSI (OR 1.82, 95% CI: [1.25-2.66]).

DISCUSSION

Psychiatric diagnoses are a risk factor for adverse outcomes after colorectal procedures. Further studies are needed to evaluate the benefit of perioperative mental health support services for these patients.

Mindfulness-Based Interventions for Perioperative Pain Management and Opioid Risk Reduction Following Surgery: A Stepped Care Approach

Surgical procedures often improve health and function but can sometimes also result in iatrogenic effects, including chronic pain and opioid misuse. Due to the known risks of opioids and the physical, emotional, and financial suffering that often accompanies chronic pain, there has been a call for greater use of complementary non-pharmacological treatments like mindfulness-based interventions. Mindfulness can be broadly described as an attentional state involving moment-by-moment meta-awareness of thoughts, emotions, and body sensations. An expanding number of randomized clinical trials have found strong evidence for the value of mindfulness techniques in alleviating clinical symptomology relevant to surgical contexts. The purpose of this review is to examine the empirical evidence for the perioperative use of mindfulness interventions. We present a mindfulness-based stepped care approach that first involves brief mindfulness to treat preoperative pain and anxiety and prevent development of postoperative chronic pain or opioid misuse. More extensive mindfulness-based interventions are then provided to patients who continue to experience high pain levels or prolonged opioid use after surgery. Finally, we review psychophysiological mechanisms of action that may be integral to the analgesic and opioid sparing effects of mindfulness.

The effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery. A randomized controlled trial

BACKGROUND

Self-affirmations help one focus on positive outcomes and adapt to new situations both psychologically and physiologically by the repetition of positive affirmation sentences. This method, which has promising results in symptom management, is predicted to have effective results in the management of pain and discomfort in patients undergoing open-heart surgery.

AIM

To investigate the effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery.

METHODS

This study adopted a randomized controlled pretest-posttest follow-up research design. The study was conducted at a public training and research hospital (Istanbul, Turkey) specialized in thoracic and cardiovascular surgery. The sample consisted of 61 patients randomized into two groups: intervention (n = 34) and control (n = 27). The participants of the intervention group listened to a self-affirmation audio recording for three days after surgery. Anxiety levels and perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured daily. The State Trait Anxiety Inventory (STAI) was used to measure the level of anxiety, meanwhile perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured by a 0 to 10 Numeric Rating Scale (NRS).

RESULTS

The control group had significantly higher anxiety than the intervention group three days after surgery (P < 0.001). The intervention group had less pain (P < 0.01), dyspnoea (P < 0.01), palpitations (P < 0.01), fatigue (P < 0.001) and nausea (P < 0.01) than the control group.

CONCLUSIONS

Positive self-affirmation helped reduce anxiety and perceived discomfort in patients who underwent open-heart surgery.

CLINICALTRIALS

gov Identifier: NCT05487430.

Preoperative Surgical Fear and Related Factors of Patients Undergoing Brain Tumor Surgery

PURPOSE

Patients with brain tumors may experience preoperative fear due to various reasons such as obscurity, pain, and loss of function. This study was carried out to reveal the pre-operative fear levels of patients undergoing brain tumor surgery.

DESIGN

This descriptive and cross-sectional study was completed with 144 patients.

METHODS

Data were obtained using patient identification forms and the Surgical Fear Questionnaire (SFQ). Descriptive statistics, independent t test, one-way Anova, Pearson correlation, and multiple regression analysis were used.

FINDINGS

The results revealed that the duration of preoperative hospital stay was 3.05 ± 2.26 days, the mean age of the patients was 51.44 ± 13.76 years, and more than half (54.1%) were male. The SFQ total and subscale mean scores of patients who are not working were higher (P < .05). The mean SFQ total and subscale mean scores of those aged 53 and over were lower. (P < .05). Duration of preoperative hospital stay, age, and female gender were statistically significant predictors of SFQ. Duration of preoperative hospital stay was responsible for 62.3% of the change in the SFQ, female gender was responsible for 17.6%, and age was responsible for 20.4%.

CONCLUSION

Understanding the risk factors for preoperative fear can help identify patients at risk. Factors that cause fear should be investigated and information deficiencies that increase the level of fear should be eliminated. It is recommended to use pharmacological and nonpharmacological methods in managing the fear of risk groups.

Comparison of Anxiety and Depression Symptoms in Individuals According to their Sex, Type of Cardiac Device, and Diagnosis of Chagas Disease

INTRODUCTION

Implantable cardiac pacemakers or cardioverter defibrillators are alternatives for the treatment of arrhythmias, however, their use has caused changes in the emotional state of patients. The objective of this study was to compare the measures of anxiety and depression symptoms in individuals according to their sex, type of cardiac device, and diagnosis of Chagas disease.

METHODS

This is an observational and cross-sectional study conducted with adults with implantable cardiac pacemakers or cardioverter defibrillators. Data was collected using a sociodemographic and clinical questionnaire and the Hospital Anxiety and Depression Scale. We used the Student's t-test for independent samples and the Chi-squared test, with a significance level of 0.05.

RESULTS

Two hundred forty-four patients participated in the study, 168 with cardiac pacemakers and 76 with implantable cardioverter defibrillators; 104 had Chagas cardiomyopathy (85 with cardiac pacemakers and 19 with implantable cardioverter defibrillators). No statistically significant differences were found in measures of anxiety and depression symptoms according to device type (P=0.594 and P=0.071, respectively) and the presence of Chagas etiology (P=0.649 and P=0.354, respectively). Women had higher mean scores for anxiety (P=0.002) and depression symptoms (P<0.001).

CONCLUSION

In the comparison between the groups, according to the type of implanted device and the diagnosis of Chagas disease, no significant differences were found in the measures of anxiety and depression symptoms. Women showed higher means when compared to men, indicating the need to test and implement interventions to minimize these symptoms in this population.

The overlooked problem among surgical patients: Preoperative anxiety at Ethiopian University Hospital

Introduction

Anxiety was repeatedly reported as the worst aspect of the perioperative time. The objective of this study was to assess the prevalence of preoperative anxiety among adult surgical patients at University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.

Methodology

A hospital-based cross-sectional study was conducted among surgical patients at the university hospital. After obtaining ethical approval, 407 surgical patients were approached during the preoperative period. Preoperative anxiety was assessed by State-Trait Anxiety Inventory. The association between variables was determined by using binary logistic regression analysis. Strength of association was described in adjusted odds ratio (AOR), and a p-value < 0.05 at 95% confidence interval was considered statistically significant.

Results

A total of 400 patients were included in this study with a 98.3% response rate. Preoperative anxiety was observed among 237 (59.3%) patients, and the median (IQR) STAI score was 50 (40-56.7); age, ≥ 60 years (AOR: 5.7, CI: 1.6-20.4, P: 0.007); emergency surgery (AOR: 2.5, CI: 1.3-4.7, P: 0.005); preoperative pain (AOR: 2.6, CI: 1.2-5.4, P: 0.005); and rural residency (AOR: 1.8, CI: 1.1-2.9, P: 0.031) were found significantly associated with preoperative anxiety.

Conclusion

The prevalence of preoperative anxiety among surgical patients was high. Older age (≥ 60 years), emergency surgery, preoperative pain, and rural residency were found significantly associated with preoperative anxiety. Assessment for preoperative anxiety should be a routine component of preoperative assessment of both elective and emergency surgical patients. Preoperative pain should be appropriately managed as it can help to reduce preoperative anxiety. Optimal anxiety reduction methods should be investigated and implemented in the hospital.

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

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 (r_pb = 0.193, p = 0.001) and pulmonary complications (r_pb = 0.104, p = 0.042). Postoperative nausea (r_pb = 0.111, p = 0.03) and postoperative mental disorders (r_pb = 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.

AUDIOVISUAL AIDS IN PREOPERATIVE CARDIAC SURGERY EDUCATION: A SCOPING REVIEW

ABSTRACT Objective: to map, in the scientific literature, the use of audiovisual aids as an educational strategy during the preoperative period of cardiac surgery. Method: a scoping review following the Joanna Briggs Institute methodology. Two independent reviewers analyzed the studies, applying the exclusion and inclusion criteria in the search by the audiovisual aid, cardiac surgery and preoperative care variables, including those that answered the research question. Results: final sample of nine studies, where the most used audiovisual aids were videos followed by apps, used because they are easily accessible and democratic. Such tools in health education optimize the team's time and promote patient education, improving the postoperative period, in addition to reducing risks and improving adherence to the treatment. Conclusion: it was possible to map the audiovisual aids used in the health education of surgical patients, such as videos, apps and information systems. These tools facilitate Nursing guidelines in the preoperative period of cardiac surgeries, increasing the patient's knowledge about the surgery.

Effect of preoperative anxiety level on postoperative pain, analgesic consumption in patients undergoing laparoscopic sleeve gastrectomy: an observational cohort study

BACKGRAUND

This prospective observational cohort study aimed to investigate the relationship between preoperative anxiety levels and postoperative pain and analgesic requirement in patients undergoing laparoscopic sleeve gastrectomy.

METHODS

Forty two female patients with body mass index ≥ 35, who underwent laparoscopic sleeve gastrectomy for treatment of obesity were included in the study. Spielberger's state and trait anxiety scales were used in this study. Demographic data of the patients, anesthetic and analgesic drugs during the surgery, pain levels measured with verbal analog scale at the postoperative 1^st, 4^th, 12^th, and 24^th hour, sedation levels measured with the Ramsay sedation scale, and the amount of analgesic consumed were recorded. Anesthesiologist, surgeon, and patient were not informed of the anxiety level results. The relationship between preoperative anxiety and postoperative pain and analgesic consumption was evaluated by Spearman's correlation analysis. Stepwise multiple linear regression analysis was applied. Normal Distribution control was performed by applying the Shapiro-Wilk test to residual values ​​obtained from the final model.

RESULTS

There was no relationship between trait anxiety level and postoperative pain and analgesic consumption. A correlation was found between state anxiety level and pain level up to 24 hours and analgesic consumption (p < 0.05). According to the obtained model it had been observed that the university graduates consumed more analgesic compared to other education level groups.

CONCLUSION

In this study, a relationship was found between preoperative state anxiety level and 24-hour pain scores and analgesic consumption in patients who underwent laparoscopic sleeve gastrectomy under general anesthesia.

Preoperative anxiety among Iranian adult patients undergoing elective surgeries in educational hospitals

BACKGROUND

Although surgical techniques have been improving, preoperative anxiety is still a challenge in preoperative care and is known as an expected response experienced by patients waiting to undergo surgery. The present study aimed to compare preoperative anxiety levels in three educational hospitals in Kerman.

MATERIALS AND METHODS

This cross-sectional study was conducted in three educational hospitals in Kerman, Iran, from December 2017 to May 2018. The participants were 100 patients from each hospital (300 patients in sum) who were selected through the convenience sampling method. Sampling was not restricted to sex and type of surgery. The 40-item Spielberger State-Trait Anxiety Inventory was administered to the patients to assess the level of preoperative anxiety experienced by them. Bivariate linear regression models were used to compare the preoperative state anxiety levels based on the patients' demographic information. A multivariate linear regression model was used to determine the predictors of preoperative state anxiety.

RESULTS

The participants were 149 males and 151 females with a mean age of 36.38 (12.75) years (age range: 12-79 years). Almost two-third of the patients showed upper-middle symptoms of state anxiety (n = 197, 65.7%) followed by upper-middle symptoms of trait anxiety (40% and 49.3%, respectively). There was a significant relationship between the patient's sex and state anxiety (P = 0.05) and also between trait anxiety and state anxiety (P ≤ 0.001). It was shown that train anxiety could predict state anxiety before surgery (B: 0.53, 95% confidence interval: 0.44, 0.62; P ≤ 0.001).

CONCLUSION

The results of the present study confirmed the presence of preoperative anxiety in a sample of Iranian patients. Although the anxiety scores were not very high, organizing intervention and training programs to control and reduce preoperative anxiety among patients seems essential.

Genetic polymorphisms are associated with alterations in anxiety levels and vital signs in patients undergoing third molar extractions

OBJECTIVE

The objective of this study was to evaluate the association between SLC6A4 (rs1042173 and rs3813034), DRD2 (rs6275 and rs6276), ANKK1 (rs1800497), and COMT (rs174675) genetic polymorphisms and alterations in anxiety levels and vital signs in individuals undergoing third molar extractions.

STUDY DESIGN

One hundred sixty-eight individuals were evaluated at the pre-, trans-, and postoperative periods by checking systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and body temperature. Anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI). Buccal mucosa cells were collected for genetic evaluation using real-time polymerase chain reaction. Statistical analysis was performed at a significance level of 5%.

RESULTS

The level of anxiety was associated with rs1800497 for STAI-Trait (P = .031) and rs174675 for STAI-State (P = .007). Considering the vital signs, there was a significant difference between the values of respiratory rate and rs1042173 (P = .029), rs3813034 (P = .024), and rs6275 (P = .025). The diastolic blood pressure values differed significantly for rs1042173 (P = .042), and the body temperature values differed significantly for rs174675 (P = .016).

CONCLUSIONS

Polymorphisms in SLC6A4, DRD2, ANKK1, and COMT genes could be associated with alterations in anxiety levels and vital signs in individuals undergoing third molar extractions.

Inflammatory indicator levels in patients undergoing aortic valve replacement via median sternotomy with preoperative anxiety and postoperative complications: a prospective cohort study

OBJECTIVE

This study was performed to evaluate the association of preoperative anxiety with inflammatory indicators and postoperative complications in patients undergoing scheduled aortic valve replacement surgery.

METHODS

A prospective cohort study was performed. The Hamilton Anxiety Scale was used to assess preoperative anxiety. The serum white blood cell (WBC) count and concentrations of C-reactive protein, interleukin (IL)-6, and IL-8 were measured 1 day preoperatively and 3 and 7 days postoperatively. Postoperative complications were also recorded.

RESULTS

Seventy-three patients were included. The incidence of preoperative anxiety was 30.1% (22/73). The payment source was the only independent risk factor for preoperative anxiety. The incidence of postoperative complications was lowest in the mild anxiety group. The WBC count 3 days postoperatively was significantly lower in the mild than moderate-severe anxiety group. The IL-8 concentration 1 day preoperatively was highest in the no anxiety group.

CONCLUSIONS

Mild preoperative anxiety might help to improve clinical outcomes. However, further investigations with more patients are warranted. Patients with different degrees of anxiety may have different levels of inflammatory cytokines.

Anxiety and Depression Symptomatology Related to Inspiratory Muscle Strength and Functional Capacity in Preoperative Cardiac Surgery Patients: A Preliminary Cross-sectional Study

BACKGROUND

Poor psychological health and cardiorespiratory fitness prior to open heart surgery (OHS) might be predictors of postoperative pulmonary complications that lead to morbidity and mortality. Assessment of physical and psychological conditions should be considered for patients receiving OHS, to possibly prevent these complications. This study investigates how inspiratory muscle strength (IMS) and functional capacity (FC) relate to the psychological health of preoperative cardiac surgery patients.

METHOD

A cross-sectional study was designed before OHS; the 6-minute walk test and IMS were performed on patients who were admitted for OHS. All participants were requested to complete Hospital Anxiety and Depression Scale. Pearson correlation and hierarchal regression analysis were performed to determine the relationships between IMS and FC and psychological conditions (anxiety and depression).

RESULTS

Overall, 36 males and 28 females aged 56.89±10.23 years were recruited. Significant relationships were observed between IMS and anxiety and depression symptoms (r = -0.33 and r = -0.27, respectively). Anxiety was negatively related to FC (r = -0.25). These relationships remained significant after adjustment for age, sex, and body mass index (BMI) (∆R 2 = 0.11 and ∆R 2 = 0.09). In addition, anxiety was also related to FC after controlling for age, sex, and BMI (∆R 2 = 0.09).

CONCLUSION

Among patients undergoing OHS, those with a higher level of depression or anxiety had a lower cardiorespiratory fitness than those with a low level of depression or anxiety.

Impacts of elective surgical cancellations and postponements in Canada

Purpose

Worldwide, patients experience difficulties accessing elective surgical care. This study examined the perceived health, social, and functional impacts of elective surgical cancellations and postponements in Canada.

Methods

We analyzed a subset of aggregate data from the Canadian Community Health Survey (CCHS) annual components from 2005 to 2014. Multivariable logistic regressions examined associations between past-year non-emergency surgical cancellations/postponements and perceived impacts of waiting for surgery (e.g., worry/stress/anxiety, pain, loss of work, loss of income, deterioration of health, relationships suffered).

Results

Among those who experienced a cancellation or postponement of a past-year non-emergency surgery (weighted n = 256,836; 11.8%), 23.5% (weighted n = 60,345) indicated their life was affected by waiting for surgery. After adjusting for type of surgery, year, and sociodemographics, those who experienced a surgical cancellation or postponement had increased odds of reporting their life was affected by waiting for surgery (adjusted odds ratio [aOR], 2.67; 99% confidence interval [CI], 1.41 to 5.1); in particular, they reported greater deterioration of their health (aOR, 3.47; 99% CI, 1.05 to 11.4) and increased dependence on relatives/friends (aOR, 2.53; 99% CI, 1.01 to 6.3) than those who did not have a cancellation or postponement.

Conclusion

Results highlight the multifaceted perceived impacts of surgical cancellations/postponements. These findings suggest there is a need for improvements in reducing elective surgical cancellations and postponements. Results may also inform the development of targeted interventions to improve patients’ health and quality of life while waiting for surgery.

[Analysis of Influencing Factors of Preoperative Anxiety or Depression in Patients with Lung Cancer Surgery]

BACKGROUND

Preoperative anxiety/depression can bring physical and mental harm to the patients with lung cancer. There is little study on whether hospital waiting time before surgery can increase the psychological burden of patients with lung cancer. The aim of this study was to investigate the preoperative anxiety and depression of patients with lung cancer in our hospital, and to analyze the related influencing factors.

METHODS

A total of 135 lung cancer inpatients in the Department of Thoracic Surgery of Beijing Friendship Hospital were studied. Their general information and anxiety/depression were recorded by general questionnaire, Zung self-rating anxiety scale (SAS) and self-rating depression scale (SDS).

RESULTS

The score of SAS was 36.25 (30.00, 42.50) on the day of admission, and 37.50 (31.25, 43.75) on one day before operation. The score of self-rating depression scale (SDS) was 46.25 (40.00, 52.50) on the day of admission, and 47.50 (41.25, 53.75) on one day before operation. Compared with the Chinese norm, there were 0 patient suffered from anxiety on the day of admission, and one day before operation. There were 2 patients suffered from mild anxiety; 6 patients suffered from mild depression on the day of admission, and this number went up to 8 on the day before operation. Single factor analysis showed that the hospital waiting time before surgery was positively correlated with preoperative anxiety and depression, and the results were statistically significant (P<0.05). The generalized linear model analysis showed that other factors such as knowledge, gender, age and marital status had no significant correlation with preoperative anxiety and depression.

CONCLUSIONS

The occurrence of preoperative anxiety in hospitalized patients with lung cancer is positively correlated to the hospital waiting time before surgery. The longer they stayed in the hospital before operation, the greater their risk of anxiety/depression. So medical staff should actively focus on the psychological condition of the patients with lung cancer, and it is strongly recommended that patients complete preoperative examination and preparation in the outpatient department, in order to reduce the waiting time before operation and reduced the risk of adverse psychological problems such as anxiety and depression.

The effect of bergamot orange essence on anxiety, salivary cortisol, and alpha amylase in patients prior to laparoscopic cholecystectomy: A controlled trial study

BACKGROUND AND PURPOSE

This study aimed to determine the effect of bergamot orange essence on anxiety, salivary cortisol, and alpha amylase in patients prior to laparoscopic cholecystectomy.

MATERIAL AND METHODS

This clinical trial with pre-post design was conducted on 60 candidates for cholecystectomy. The participants were randomly divided into an intervention and a control group. The intervention group participants underwent aromatherapy using two drops of 3% bergamot orange essence, while the control group ones inhaled two drops of odourless grape seed oil. Anxiety mean score and salivary cortisol and alpha amylase levels were measured before and after the intervention.

RESULTS

A significant difference was found between the groups regarding anxiety (F = 9.00, p = 0.004) and alpha amylase level (F = 9.46, p = 0.003) after the intervention.

CONCLUSION

Bergamot orange essence decreased anxiety and salivary alpha amylase level. Therefore, this method can be used as a complementary technique to reduce patients' anxiety prior to laparoscopic cholecystectomy surgery.

IRCT REGISTRATION NUMBER

IRCT20171113037428N2. It is available in following website: https://www.irct.ir/trial/27696 REGISTRATION DATE: 03/25/2018.

[Effect of Preoperative Anxiety on Early Prognosis of Patients after Thoracoscopic Lung Cancer Resection]

背景与目的

肺癌患者常伴焦虑，影响术后恢复。本研究旨在观察术前焦虑对胸腔镜肺癌根治术后患者早期预后的影响。

方法

以胸腔镜肺癌根治术患者100例为研究对象，术前采用医院焦虑抑郁量表（hospital anxiety and depression scale, HADS）对患者进行评估，其中焦虑患者44例（焦虑评分≥8分）纳入焦虑组；非焦虑患者56例（焦虑评分 < 8分）纳入对照组，术后随访患者早期预后指标。主要研究终点：患者术后住院时间；次要研究终点：患者总住院时间、术后视觉模拟疼痛评分（visual analogue scale, VAS）、术后恶心呕吐及新发心律失常发生率、术后镇痛药和补救止吐药用量。

结果

相对于对照组，焦虑组术后住院时间及总住院时间均明显延长[（5.1±2.5）d vs（4.0±1.3）d，P < 0.01；（10.9±4.0）d vs（9.1±4.1）d，P < 0.05]；术后VAS评分、恶心及新发心律失常发生率显著增高[（4.7±1.9）分vs（2.6±1.8）分，P < 0.001；40.9% vs 16.1%，P < 0.01；36.4% vs 20.7%，P < 0.05]；术后镇痛药和补救止吐药用量增多[(72.5±8.9) mL vs (68.2±9.4) mL, P < 0.05; (2.1±2.9) mg vs (0.9 ± 1.9) mg, P < 0.05]。

结论

术前焦虑可影响胸腔镜肺癌根治术后患者早期预后，延长住院时间，增加患者术后VAS评分、恶心及新发心律失常发生率，增加术后镇痛药及补救止吐药用量。