A multicenter survey of perioperative anxiety in China: Pre- and postoperative associations
Introduction
Surgery is a significant event in the initiation of anxiety. An observational study in over 15,000 patients suggested that one of the burdensome experiences related to surgical procedure was anxiety [1]. Preoperative anxiety has a high incidence, ranging from 11% to 80% in different clinical disciplines [2]. Moreover, worldwide, it is estimated that 266–360 million operations are performed annually [3]. And as the number of surgeries continues to rise, the number of patients experiencing anxiety will as well. This is a serious public health problem.
Preoperative anxiety has been described as one negative factor in anesthesia management and surgical outcome. It is associated with many adverse physiological manifestations, such as hypertension, tachycardia, and even arrhythmia [4]. According to recent studies results, anxiety was associated with hypotension after spinal anesthesia and shivering during cesarean delivery [5,6]. These reactions may increase adverse events, requiring the anesthesiologists to adjust the dose of anesthetics and vasoactive drugs [7]. Some studies suggest that preoperative anxiety has a positive correlation with postoperative pain [8] and nausea and vomiting (PONV) [9], and in rare circumstances may be an independent risk factor for postoperative mortality [10,11]. Therefore, anesthesiologists need to explore risk factors for preoperative anxiety to identify mitigation strategies.
This is the most extensive study to date to evaluate preoperative anxiety in China. Our principal objective was to describe patient characteristics associated with preoperative anxiety. Secondly, we aimed to assess the relationship between preoperative anxiety and postoperative anxiety, pain, sleep quality, nausea and vomiting.
Section snippets
Methods
Ethical approval was obtained from the Institutional Review Board of the Aviation General Hospital of China Medical University (approval number HK2019-01-13). The survey was carried out only after the patients signed an informed consent, which met the requirements of the Helsinki Declaration. All subjects had the right to withdraw from this study at any time. All personal information was kept confidential.
Demographic and surgical information of patients
Despite the plan to include 1200 patients, we received 1146 (95.5%) survey results. Excluding 149 patients with missing data of preoperative anxiety, a total of 997 subjects were included in the final analysis. The median (interquartile range: 25th–75th percentile) of age of participants was 51 (39–61). The proportion of female patients was 55.9%. Further demographic and clinical information are provided in Table 1, Table 2 respectively. Additionally, the specific surgical types from head-neck,
Discussion
In the present study, 258 (25.9%) patients were in high anxiety preoperatively (STAI-S>44). Their median score (interquartile range: 25th–75th percentile) of the STAI-S was 50 (48–55). However, this prevalence was lower than previously reported [29]. This could be due to differences in the assessment tools of anxiety. Since there are more than 40 million surgical procedures performed annually in China [3], this means that the presence of a high anxiety state exists in at least 10.4 million
Limitations
There are several limitations to this investigation. Firstly, we cannot conclude that there is any causal and temporal relationship between high preoperative anxiety and insomnia. Further, we only roughly analyzed the correlation between preoperative anxiety and postoperative status (anxiety, pain, sleep quality nausea and vomiting) with regard to the level of invasiveness of surgery and we cannot exclude other confounding factors.
Conclusion and clinical implications
Results of our study suggest that high preoperative anxiety is common for patients scheduled to undergo an elective surgery. The independent risk factors for high preoperative anxiety included female gender, highly invasive surgery, higher trait anxiety and insomnia. Identifying modifiable factors may help to plan a proper intervention. Most patients regarded surgical effects, postoperative pain and anesthesia safety as their most significant concerns before surgery. This suggests that
Funding statement
This survey was funded by the National Natural Science Foundation of China, Beijing, China (81671076).
Declaration of Competing Interest
The authors declare no competing interests.
Acknowledgement
This research was supported by the National Natural Science Foundation of China. (81671076). We expressed the deepest gratitude to the anonymous reviewers for their careful work and thoughtful suggestions.
References (48)
- et al.
Influence of preoperative anxiety on hypotension after spinal anaesthesia in women undergoing Caesarean delivery
Br. J. Anaesth.
(2012) - et al.
Preoperative anxiety and postoperative pain in women undergoing hysterectomy. A repeated-measures design
J. Psychosom. Res.
(2000) - et al.
Assessment of preoperative anxiety in cardiac surgery patients lacking a history of anxiety: contributing factors and postoperative morbidity
J. Cardiothorac. Vasc. Anesth.
(2018) - et al.
Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery
Am. J. Cardiol.
(2013) - et al.
Assessment of preoperative anxiety: comparison of measures in patients awaiting surgery for breast cancer
Br. J. Anaesth.
(1995) - et al.
Athens Insomnia Scale: validation of an instrument based on ICD-10 criteria
J. Psychosom. Res.
(2000) - et al.
Effect of insomnia after acute ischemic stroke on cerebrovascular reactivity: a prospective clinical study in China
Sleep Med.
(2019) - et al.
Assessing insomnia in adolescents: comparison of Insomnia Severity Index, Athens Insomnia Scale and Sleep Quality Index
Sleep Med.
(2011) - et al.
A cross-sectional study on preoperative anxiety in adults
J. Psychosom. Res.
(2018) How might circadian rhythms control mood? Let me count the ways
Biol. Psychiatry
(2013)
Insomnia and short sleep predict anxiety and worry in response to stress exposure: a prospective cohort study of medical interns
Sleep Med.
Trait anxiety and sleep-onset insomnia: evaluation of treatment using anxiety management training
J. Psychosom. Res.
The effects of preoperative, video-assisted anesthesia education in Spanish on Spanish-speaking patients’ anxiety, knowledge, and satisfaction: a pilot study
J. Clin. Anesth.
Assessment and management of preoperative anxiety
J. Voice
The impact of preoperative patient anxiety on postoperative anxiety and quality of recovery after orthopaedic surgery
J. Perianesth. Nurs.
Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study
Br. J. Anaesth.
Melatonin for preoperative and postoperative anxiety in adults
Cochrane Database Syst. Rev.
Size and distribution of the global volume of surgery in 2012
Bull. World Health Organ.
High anxiety in clinically healthy patients and increased QT dispersion: a meta-analysis
Eur. J. Prev. Cardiol.
Risk factors for shivering during caesarean section under spinal anaesthesia. A prospective observational study
Acta Anaesthesiol. Scand.
The effect of preoperative anxiety level on mean platelet volume and propofol consumption
BMC Anesthesiol.
Is ‘anxiety sensitivity’ predictive of postoperative nausea and vomiting?: a prospective observational study
Eur. J. Anaesthesiol.
Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia
BMC Surg.
Preoperative anxiety and implications on postoperative recovery: what can we do to change our history
Minerva Anestesiol.
Cited by (26)
Preoperative psychological symptoms and chronic postsurgical pain: analysis of the prospective China Surgery and Anaesthesia Cohort study
2024, British Journal of AnaesthesiaTurkish Validity and Reliability Study of the Surgical Anxiety Questionnaire for Adult Patients
2023, Journal of Perianesthesia NursingEffect of Electroacupuncture Based on ERAS for Preoperative Anxiety in Breast Cancer Surgery: A Single-Center, Randomized, Controlled Trial
2022, Clinical Breast CancerCitation Excerpt :Therefore, the relationship between preoperative anxiety and PONV needs to be further explored. In a multicenter survey conducted in China, preoperative anxiety was found to be related to more severe pain postoperatively.39 In this study, EA showed a better effect in improving the 24 hours postoperative VAS score.
- 1
Xi-Rong Li and Wen-Hao Zhang are co-first authors. They contributed equally to the work.