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Holzer KJ, Bollepalli H, Carron J, Yaeger LH, Avidan MS, Lenze EJ, Abraham J. The impact of compassion-based interventions on perioperative anxiety and depression: A systematic review and meta-analysis. J Affect Disord 2024:S0165-0327(24)01339-9. [PMID: 39182519 DOI: 10.1016/j.jad.2024.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 08/27/2024]
Abstract
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.
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Affiliation(s)
- Katherine J Holzer
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
| | | | | | - Lauren H Yaeger
- Becker Medical Library, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael S Avidan
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA; Institute for Informatics, Data Science and Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
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2
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Zulfiqar R, Mustufa I, Soomro A. Critique on "Anxiety and quality of life outcomes after coronary artery bypass graft surgery-A prospective cohort study". Curr Probl Cardiol 2024; 49:102531. [PMID: 38508348 DOI: 10.1016/j.cpcardiol.2024.102531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Rakhshan Zulfiqar
- Medicine Department, Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Parsa citi Block E Floor 5th Flat 501 near police headquarters, Garden East Karachi, Karachi, Pakistan, 75660.
| | - Iqra Mustufa
- Medicine Department, Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Parsa citi Block E Floor 5th Flat 501 near police headquarters, Garden East Karachi, Karachi, Pakistan, 75660
| | - Aiman Soomro
- Medicine Department, Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Shaheed Mohtarma Benazir Bhutto Medical College Liyari, Parsa citi Block E Floor 5th Flat 501 near police headquarters, Garden East Karachi, Karachi, Pakistan, 75660
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3
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Aghajanian S, Shafiee A, Teymouri Athar MM, Mohammadifard F, Goodarzi S, Esmailpur F, Elsamadicy AA. Impact of Depression on Postoperative Medical and Surgical Outcomes in Spine Surgeries: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:3247. [PMID: 38892958 PMCID: PMC11172961 DOI: 10.3390/jcm13113247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: The relationship between psychiatric disorders, including depression, and invasive interventions has been a topic of debate in recent literature. While these conditions can impact the quality of life and subjective perceptions of surgical outcomes, the literature lacks consensus regarding the association between depression and objective perioperative medical and surgical complications, especially in the neurosurgical domain. Methods: MEDLINE (PubMed), EMBASE, PsycINFO, and the Cochrane Library were queried in a comprehensive manner from inception until 10 November 2023, with no language restrictions, for citations investigating the association between depression and length of hospitalization, medical and surgical complications, and objective postoperative outcomes including readmission, reoperation, and non-routine discharge in patients undergoing spine surgery. Results: A total of 26 articles were considered in this systematic review. Upon pooled analysis of the primary outcome, statistically significantly higher rates were observed for several complications, including delirium (OR:1.92), deep vein thrombosis (OR:3.72), fever (OR:6.34), hematoma formation (OR:4.7), hypotension (OR:4.32), pulmonary embolism (OR:3.79), neurological injury (OR:6.02), surgical site infection (OR:1.36), urinary retention (OR:4.63), and urinary tract infection (OR:1.72). While readmission (OR:1.35) and reoperation (OR:2.22) rates, as well as non-routine discharge (OR:1.72) rates, were significantly higher in depressed patients, hospitalization length was comparable to non-depressed controls. Conclusions: The results of this review emphasize the significant increase in complications and suboptimal outcomes noted in patients with depression undergoing spinal surgery. Although a direct causal relationship may not be established, addressing psychiatric aspects in patient care is crucial for providing comprehensive medical attention.
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Affiliation(s)
- Sepehr Aghajanian
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
- Neuroscience Research Center, Iran University of Medical Sciences, Tehran 14496-14535, Iran
| | - Arman Shafiee
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
| | | | - Fateme Mohammadifard
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
| | - Saba Goodarzi
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
| | - Fatemeh Esmailpur
- Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj 3198764653, Iran; (S.A.); (F.E.)
| | - Aladine A. Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06520, USA
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Lee S, Xue Y, Petricca J, Kremic L, Xiao MZX, Pivetta B, Ladha KS, Wijeysundera DN, Diep C. The impact of pre-operative depression on pain outcomes after major surgery: a systematic review and meta-analysis. Anaesthesia 2024; 79:423-434. [PMID: 38050423 DOI: 10.1111/anae.16188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/06/2023]
Abstract
Symptoms of depression are common among patients before surgery. Depression may be associated with worse postoperative pain and other pain-related outcomes. This review aimed to characterise the impact of pre-operative depression on postoperative pain outcomes. We conducted a systematic review of observational studies that reported an association between pre-operative depression and pain outcomes after major surgery. Multilevel random effects meta-analyses were conducted to pool standardised mean differences and 95%CI for postoperative pain scores in patients with depression compared with those without depression, at different time intervals. A meta-analysis was performed for studies reporting change in pain scores from the pre-operative period to any time-point after surgery. Sixty studies (n = 501,962) were included in the overall review, of which 18 were eligible for meta-analysis. Pre-operative depression was associated with greater pain scores at < 72 h (standardised mean difference 0.97 (95%CI 0.37-1.56), p = 0.009, I2 = 41%; moderate certainty) and > 6 months (standardised mean difference 0.45 (95%CI 0.23-0.68), p < 0.001, I2 = 78%; low certainty) after surgery, but not at 3-6 months after surgery (standardised mean difference 0.54 (95%CI -0.06-1.15), p = 0.07, I2 = 83%; very low certainty). The change in pain scores from pre-operative baseline to 1-2 years after surgery was similar between patients with and without pre-operative depression (standardised mean difference 0.13 (95%CI -0.06-0.32), p = 0.15, I2 = 54%; very low certainty). Overall, pre-existing depression before surgery was associated with worse pain severity postoperatively. Our findings highlight the importance of incorporating psychological care into current postoperative pain management approaches in patients with depression.
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Affiliation(s)
- S Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - J Petricca
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Kremic
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Z X Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - B Pivetta
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - K S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Canada
| | - D N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Canada
| | - C Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
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Preoperative mental illness and postoperative atrial fibrillation in cardiac surgery patients: Identifying a vulnerable population. J Clin Transl Sci 2023; 7:e15. [PMID: 36755550 PMCID: PMC9879927 DOI: 10.1017/cts.2022.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/29/2022] [Accepted: 10/10/2022] [Indexed: 11/16/2022] Open
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The Impact of Depression in Patients Undergoing Emergency Abdominal Surgery: An Exploratory Study. World J Surg 2023; 47:835-842. [PMID: 36402919 PMCID: PMC9676747 DOI: 10.1007/s00268-022-06837-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Depression is associated with poorer outcomes in many disease states. However, its significance in abdominal surgery is unknown. This study investigated rates of depression in emergency abdominal surgery patients and its effects on outcomes. METHODS A retrospective cohort study was conducted across two UK sites and included all adult patients undergoing emergency abdominal surgery. Primary outcome was the complication rate in depressed patients, including the incidence of post-operative delirium. Secondary outcomes included mortality, time to oral intake and analgesia. RESULTS Two hundred and ten patients were identified. The commonest indication for surgery was appendicitis (53.3%) followed by small bowel obstruction (9.5%). There was a 17% (n = 36) incidence of depression amongst patients, most of whom (n = 26, 72.2%) were taking antidepressants. Depression was associated with male sex (M:F 27:9 p = 0.003), higher median BMI (28 vs. 25 p = 0.013) and previous surgery (47.2% vs. 28.7% p = 0.032). Despite a higher incidence of post-operative delirium, increased time to oral analgesia and greater 30-day readmission rates in the depression cohort, multivariate analyses showed depression was not a significant independent predictor of these (OR 2.181, 95%CI 0.310-15.344; p = 0.433, OR 0.07, 95%CI 0.499-1.408; p = 0.348 and OR 1.367, 95%CI 0.102-18.34, respectively). Complication and mortality rates between depressed and non-depressed individuals were similar. CONCLUSION Significant numbers of patients undergoing emergency abdominal surgery have depression, but this did not adversely affect post-operative outcomes. The study included relatively small numbers of participants undergoing procedures with straightforward recovery. Larger population studies are therefore required and should focus on investigating the association between major emergency surgeries with post-operative delirium and uncontrolled pain.
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Subramanian H, Knight J, Sultan I, Kaczorowski DJ, Subramaniam K. Pre-Habilitation of Cardiac Surgical Patients, Part 2: Frailty, Malnutrition, Respiratory disease, Alcohol/Smoking cessation and Depression. Semin Cardiothorac Vasc Anesth 2022; 26:295-303. [PMID: 36189933 DOI: 10.1177/10892532221130922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The concept of "pre-habilitation" comprises screening for and identification of pre-existing disorders followed by medical optimization. This is performed for many types of surgeries, but may have profound impacts on outcomes, particularly in cardiac surgery given the multiple comorbidities typically carried by these patients. Components of pre-habilitation include direct medical intervention by preoperative specialists as well as significant care coordination and shared decision-making. In this second part of a two-part review, the authors describe existing evidence to support the optimization of various preoperative problems and present a few institutional protocols utilized at out center for cardiac presurgical care. This second installment will focus on alcohol and smoking cessation and the management of frailty, malnutrition, respiratory disease, and depression.
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Affiliation(s)
- Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Joshua Knight
- Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, 481457University of Pittsburgh Medical center, Pittsburgh, PA, USA
| | - David J Kaczorowski
- Department of Cardiothoracic Surgery, 481457University of Pittsburgh Medical center, Pittsburgh, PA, USA
| | - Kathirvel Subramaniam
- Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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The effects of aerobic exercise and sertraline on pro-inflammatory indices and amelioration of neurotrophic factors in patients who have undergone CABG. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Lewis C, Dokucu ME, Brown CH, Balmert L, Srdanovic N, Madhan AS, Samra SS, Csernansky J, Grafman J, Hogue CW. Postoperative but not preoperative depression is associated with cognitive impairment after cardiac surgery: exploratory analysis of data from a randomized trial. BMC Anesthesiol 2022; 22:157. [PMID: 35606688 PMCID: PMC9125857 DOI: 10.1186/s12871-022-01672-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In this study we hypothesize that depression is associated with perioperative neurocognitive dysfunction and altered quality of life one month after surgery. METHODS Data were obtained as part of a study evaluating cerebral autoregulation monitoring for targeting arterial pressure during cardiopulmonary bypass. Neuropsychological testing was performed before surgery and one month postoperatively. Testing included the Beck Depression Inventory, a depression symptoms questionnaire (0-63 scale), as well as anxiety and quality of life assessments. Depression was defined as a Beck Depression Inventory score > 13. RESULTS Beck Depression data were available from 320 patients of whom cognitive domain endpoints were available from 88-98% at baseline and 69-79% after surgery. This range in end-points data was due to variability in the availability of each neuropsychological test results between patients. Depression was present in 50 (15.6%) patients before surgery and in 43 (13.4%) after surgery. Baseline depression was not associated with postoperative domain-specific neurocognitive function compared with non-depressed patients. Those with depression one month after surgery, though, had poorer performance on tests of attention (p = 0.017), memory (p = 0.049), verbal fluency (p = 0.010), processing speed (p = 0.017), and fine motor speed (p = 0.014). Postoperative neurocognitive dysfunction as a composite outcome occurred in 33.3% versus 14.5% of patients with and without postoperative depression (p = 0.040). Baseline depression was associated with higher anxiety and lower self-ratings on several quality of life domains, these measures were generally more adversely affected by depression one month after surgery. CONCLUSIONS The results of this exploratory analysis suggests that preoperative depression is not associated with perioperative neurocognitive dysfunction, but depression after cardiac surgery may be associated with impairment in in several cognitive domains, a higher frequency of the composite neurocognitive outcome, and altered quality of life. TRIAL REGISTRATION www. CLINICALTRIALS gov, NCT00981474 (parent study).
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Affiliation(s)
- Choy Lewis
- Department of Anesthesiology, The Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, 251 East Huron St, Feinberg 5-704, Chicago, IL, 60611, USA
| | - Mehmet E Dokucu
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Charles H Brown
- Department of Anesthesiology & Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren Balmert
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nina Srdanovic
- Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ashwin Shaan Madhan
- Medical Student, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sahej Singh Samra
- Medical Student, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John Csernansky
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jordan Grafman
- Department of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Northwestern University Feinberg School of Medicine, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Charles W Hogue
- Department of Anesthesiology, The Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, 251 East Huron St, Feinberg 5-704, Chicago, IL, 60611, USA.
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Sanders J, Bowden T, Woolfe-Loftus N, Sekhon M, Aitken LM. Predictors of health-related quality of life after cardiac surgery: a systematic review. Health Qual Life Outcomes 2022; 20:79. [PMID: 35585633 PMCID: PMC9118761 DOI: 10.1186/s12955-022-01980-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is important in determining surgical success, particularly from the patients' perspective. AIMS To identify predictors for HRQoL outcome after cardiac surgery in order to identify potentially modifiable factors where interventions to improve patient outcomes could be targeted. METHODS Electronic databases (including MEDLINE, CINAHL, Embase) were searched between January 2001 and December 2020 for studies determining predictors of HRQoL (using a recognised and validated tool) in adult patients undergoing cardiac surgery. Data extraction and quality assessments were undertaken and data was summarised using descriptive statistics and narrative synthesis, as appropriate. RESULTS Overall, 3924 papers were screened with 41 papers included in the review. Considerable methodological heterogeneity between studies was observed. Most were single-centre (75.6%) prospective observational studies (73.2%) conducted in patients undergoing coronary artery bypass graft (CABG) (n = 51.2%) using a version of the SF-36 (n = 63.4%). Overall, 103 independent predictors (62 pre-operative, five intra-operative and 36 post-operative) were identified, where 34 (33.0%) were reported in more than one study. Potential pre-operative modifiable predictors include alcohol use, BMI/weight, depression, pre-operative quality of life and smoking while in the post-operative period pain and strategies to reduce post-operative complications and intensive care and hospital length of stay are potential therapeutic targets. CONCLUSION Despite a lack of consistency across studies, several potentially modifiable predictors were identified that could be targeted in interventions to improve patient or treatment outcomes. This may contribute to delivering more person-centred care involving shared decision-making to improve patient HRQoL after cardiac surgery.
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Affiliation(s)
- Julie Sanders
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7DN, UK.
- William Harvey Research Institute, Charterhouse Square, Queen Mary University of London, London, EC1M 6BQ, UK.
| | - Tracey Bowden
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Nicholas Woolfe-Loftus
- St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, EC1A 7DN, UK
| | - Mandeep Sekhon
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Leanne M Aitken
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, 4111, Australia
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Jarmoszewicz K, Topolski M, Hajduk A, Banaszkiewicz D, Nowicka-Sauer K. Prevalence and Predictors of Suicidal Ideation in Patients Following Cardiac Surgery. World J Surg 2022; 46:1997-2004. [PMID: 35554632 DOI: 10.1007/s00268-022-06582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) which demand special attention and immediate help are referred to as PROs alert. Suicidal ideation (SI) is one of the PROs alerts which are insufficiently investigated. The aim was to assess the prevalence and risk factors for SI in patients following cardiac surgery. METHODS A total of 190 patients (mean age: 66.09, SD = 10.19; 57 women) were assessed at three months following cardiac surgery. SI was identified using the Patient Health Qustionnaire-9 (PHQ-9) question. The Hospital Anxiety and Depression Scale-Modified was used to assess anxiety, depression, and irritability. Additionally, self-perceived health improvement and level of hope were assessed using the Likert scale. Dyspnea and chest pain were assessed using a visual analogue scale. RESULTS SI was observed in 14.7% of participants. Patients experiencing SI had significantly higher levels of depression, anxiety, irritability, dyspnea and chest pain. They perceived the surgery to be less effective and had lower levels of hope. No significant relationships were found regarding age, sex, employment status, myocardial infarction, heart failure, operation mode, type of procedure, extracorporal circulation, hospital stay and postsurgical complications. Logistic regression revealed female sex (B = 2.363), higher anxiety level (B = 0.451) and older age (B = 0.062) to be risk factors for SI. The total variance explained by the model was 46%. CONCLUSIONS Assessing suicidality and negative emotions with special emphasis on anxiety simultaneously with somatic complaints is vital to address PROs alerts and improve care for patients following cardiac surgery. In-depth evaluation and psychological care are recommended in case of positive screening.
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Affiliation(s)
- Krzysztof Jarmoszewicz
- Department of Cardiac Surgery, Ceynowa Specialist Hospital, Dr. Jagalski Str. 10, 84-200, Wejherowo, Poland.
| | - Mariusz Topolski
- Department of Systems and Computer Networks, Faculty of Information and Communication Technology, Wrocław University of Science and Technology, Wrocław, Poland
| | - Adam Hajduk
- Department of Internal Medicine, Connective Tissue Diseases and Geriatrics, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Dorota Banaszkiewicz
- Department of Statistics, Faculty of Management, Gdańsk University, Sopot, Poland
| | - Katarzyna Nowicka-Sauer
- Department of Cardiac Surgery, Ceynowa Specialist Hospital, Dr. Jagalski Str. 10, 84-200, Wejherowo, Poland
- Department of Family Medicine, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Yılmaz E, Balcı H, Başer G, Özkalp B. Pain fear levels and affecting factors of health students in the university. Work 2022; 71:1043-1050. [DOI: 10.3233/wor-205054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Fear of pain, which is defined as verbal, physiological, and behavioral responses against potentially painful situations, refers to extreme fear of pain, painful sensation, and anything that may cause this sensation. OBJECTIVE: This study aimed to determine the pain fear levels of students and factors affecting fear of pain. METHODS: The study sample consisted of 544 students. To measure the students’ pain fear levels, a 12-item questionnaire, developed by the researchers, and 30-item Fear of Pain Questionnaire-III (FPQ-III) was used. Data were analyzed using the SPSS software. RESULTS: Students the severity of pain subscale, 31.9±8.9; mild pain subscale, 23.8±7.5; medical pain subscale, 27.5±9.0; and average total FPQ score, 83.1±22.0 was foud as. Of the students participating in the study, 80% reported that they had previously experienced pain. Of those who experienced pain, 32.9% reported dysmenorrhea, 18.2% reported headache, and 16.6% reported posttraumatic pain. Moreover, 61.0% of the students attempted to relieve their pain by their own means (medicine, herbal medicine, hot–cold application, etc.), while 70.6% stated that they do not frequently use painkillers. CONCLUSION: It is recommended to develop multidisciplinary and interdisciplinary approaches in the management of fear of pain, which has biological, psychological, social, cultural, economic aspects.
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Affiliation(s)
- Evre Yılmaz
- First and Immediate Aid Program, Medical Services and Techniques Department, KTO Karatay University, Karatay, Turkey
| | - Hatice Balcı
- Dialysis Program, Medical Services and Techniques Department, KTO Karatay University, Karatay, Turkey
| | - Gülfidan Başer
- Dialysis Program, Medical Services and Techniques Department, KTO Karatay University, Karatay, Turkey
| | - Birol Özkalp
- Medicine Department, KTO Karatay University, Karatay, Turkey
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13
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Ng SX, Wang W, Shen Q, Toh ZA, He HG. The effectiveness of preoperative education interventions on improving perioperative outcomes of adult patients undergoing cardiac surgery: a systematic review and meta-analysis. Eur J Cardiovasc Nurs 2021; 21:521-536. [PMID: 34964470 DOI: 10.1093/eurjcn/zvab123] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/25/2021] [Accepted: 12/09/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cardiac surgeries pose as an emotional experience for patients. Preoperative education is known to positively alter people's perceptions, emotions, and mitigate surgical distress. However, this intervention's effectiveness in improving perioperative outcomes among patients undergoing cardiac surgery lacked rigorous statistical synthesis and remains inconclusive. AIMS The aim was to synthesize the effectiveness of preoperative education on improving perioperative outcomes [anxiety, depression, knowledge, pain intensity, pain interference with daily activities, postoperative complications, length of hospitalization, length of intensive care unit (ICU) stay, satisfaction with the intervention and care, and health-related quality of life] among patients undergoing cardiac surgery. METHODS This systematic review and meta-analysis conducted a comprehensive search of nine electronic databases (PubMed, EMBASE, Scopus, MEDLINE, CINAHL, Cochrane CENTRAL, Web of Science, PsycINFO, and ERIC) and grey literature for randomized controlled trials examining the preoperative educational interventional effects on patients undergoing cardiac surgery from inception to 31 December 2020. The studies' quality was evaluated using Cochrane Risk-of-Bias Tool 1 (RoB1). Meta-analyses via RevMan 5.4 software synthesized interventional effects. RESULTS Twenty-two trials involving 3167 participants were included. Preoperative education had large significant effects on reducing post-intervention preoperative anxiety (P = 0.02), length of ICU stay (P = 0.02), and improving knowledge (P < 0.00001), but small significant effect sizes on lowering postoperative anxiety (P < 0.0001), depression (P = 0.03), and enhancing satisfaction (P = 0.04). CONCLUSIONS This review indicates the feasibility of preoperative education in clinical use to enhance health outcomes of patients undergoing cardiac surgery. Future studies need to explore knowledge outcomes in-depth and more innovative technologies in preoperative education delivery.
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Affiliation(s)
- Si Xian Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.,National University Health System, NUHS Tower Block, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.,National University Health System, NUHS Tower Block, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Qu Shen
- Department of Nursing, School of Medicine, Xiamen University, Room 220, Alice Lee Building, Xiang An South Road, Xiang An District, Xiamen 361102, Fujian Province, China
| | - Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.,National University Health System, NUHS Tower Block, 1E Kent Ridge Rd, Singapore 119228, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore 117597, Singapore.,National University Health System, NUHS Tower Block, 1E Kent Ridge Rd, Singapore 119228, Singapore
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14
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Zhang GQ, Canner JK, Prince EJ, Stem M, Taylor JP, Efron JE, Atallah C, Safar B. History of depression is associated with worsened postoperative outcomes following colectomy. Colorectal Dis 2021; 23:2559-2566. [PMID: 34166552 DOI: 10.1111/codi.15790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/21/2021] [Accepted: 06/10/2021] [Indexed: 02/08/2023]
Abstract
AIM Depression is a prevalent disorder that is associated with adverse health outcomes, but an understanding of its effect in colorectal surgery remains limited. The purpose of this study was to examine the impact of history of depression among patients undergoing colectomy. METHOD United States patients from Marketscan (2010-2017) who underwent colectomy were included and stratified by whether they had a history of depression within the past year, defined as (1) a diagnosis of depression during the index admission, (2) a diagnosis of depression during any inpatient or (3) outpatient admission within the year, and/or (4) a pharmacy claim for an antidepressant within the year. The primary outcomes were length of stay (LOS) and inpatient hospital charge. Secondary outcomes included in-hospital mortality and postoperative complications. Logistic, negative binomial, and quantile regressions were performed. RESULTS Among 88 981 patients, 21 878 (24.6%) had a history of depression. Compared to those without, patients with a history of depression had significantly longer LOS (IRR = 1.06, 95% CI [1.05, 1.07]), increased inpatient charge (β = 467, 95% CI [167, 767]), and increased odds of in-hospital mortality (OR = 1.37, 95% CI [1.08, 1.73]) after adjustment. History of depression was also independently associated with increased odds of respiratory complication, pneumonia, and delirium (all P < 0.05). CONCLUSION History of depression was prevalent among individuals undergoing colectomy, and associated with greater mortality and inpatient charge, longer LOS, and higher odds of postoperative complication. These findings highlight the impact of depression in colorectal surgery patients and suggest that proper identification and treatment may reduce postoperative morbidity.
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Affiliation(s)
- George Q Zhang
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph K Canner
- Department of Surgery, Johns Hopkins Surgery Center for Outcomes Research, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Elizabeth J Prince
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Miloslawa Stem
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James P Taylor
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan E Efron
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chady Atallah
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bashar Safar
- Colorectal Research Unit, Ravitch Colorectal Division, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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15
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Czarnecka J, Kobos E, Sienkiewicz Z. Disease acceptance and social support in patients with peripheral vascular diseases treated in the surgical ward. Nurs Open 2021; 8:2949-2961. [PMID: 34355524 PMCID: PMC8510715 DOI: 10.1002/nop2.1007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/24/2021] [Accepted: 07/10/2021] [Indexed: 11/11/2022] Open
Abstract
Aim The purpose of this study is a comparative analysis of the degree of disease acceptance and social support in patients with peripheral vascular diseases and other medical conditions treated in surgery ward. Design A cross‐sectional study. Methods This cross‐sectional study compares disease acceptance and social support in a group of 212 patients with peripheral vascular diseases and other conditions treated in surgery ward. A standardized Acceptance of Illness Scale (AIS) and Social Support Scale were used to collect the research data. Results Overall, on the AIS, 14% of patients with surgical diseases and 34% of patients with vascular diseases had a low disease acceptance rate. A high level of support was demonstrated in 41% of study participants with surgically treated diseases and in 17% of participants with vascular diseases.
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Affiliation(s)
- Józefa Czarnecka
- Department of Development of Nursing, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Kobos
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | - Zofia Sienkiewicz
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
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16
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Fatehi Hassanabad A, Bahrami N, Novick RJ, Ali IS. Delirium and depression in cardiac surgery: A comprehensive review of risk factors, pathophysiology, and management. J Card Surg 2021; 36:2876-2889. [PMID: 34120376 DOI: 10.1111/jocs.15610] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Mental health and wellbeing continue to gain more attention as they are inextricably associated with clinical outcomes, particularly quality of life. Many medical ailments and major surgeries affect patients' mental health, including depression and delirium. AIMS The objective of this manuscript was to comprehensively review and critically examine the literature pertaining to cardiac surgery, depression, and delirium. METHODS This is a narrative review article. We performed our search analysis by using the following key words: "Cardiac Surgery", "Depression", "Delirium", "Clinical outcomes", and "Mental Health". Search analysis was done on MedLine PubMed, accessing indexed peer-reviewed publications. RESULTS Cardiac Surgery is a life-altering intervention indicated to improve morbidity and mortality in patients with cardiovascular diseases. Psychiatric conditions before and after cardiac surgery worsen patient prognosis and increase mortality rate. Specifically, preoperative depression increases postoperative depression and is associated with impaired functional status, slow physical recovery, and an increased readmission rate. DISCUSSION Although the exact pathophysiology between depression and cardiovascular disease (CVD) is unknown, several pathways have been implicated. Unmanaged depression can also lead to other psychological conditions such as delirium. Like depression, the exact association between delirium and CVD is not well understood, but believed to be multifactorial. CONCLUSION Herein, we provide a comprehensive review of the links between depression, delirium, and cardiovascular surgery. We critically examine the current data that pertains to the pathophysiology of these debilitating mental health issues in the context of cardiac surgery. Finally, we summarize the various treatment options available for managing depression and delirium in the cardiac surgery patient population.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Nabila Bahrami
- Department of Medicine, Department of Medicine, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Richard J Novick
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Imtiaz S Ali
- Section of Cardiac Surgery, Department of Cardiac Sciences, Cumming School of Medicine, Libin Cardiovascular Institute, Calgary, Alberta, Canada
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17
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Restoring VTA DA neurons excitability accelerates emergence from sevoflurane general anesthesia of anxiety state. Biochem Biophys Res Commun 2021; 565:21-28. [PMID: 34090206 DOI: 10.1016/j.bbrc.2021.05.079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022]
Abstract
Preoperative anxiety is common and often comes with a higher probability of worse recovery. However, the neurological mechanism of the effect of preoperative anxiety on general anesthesia and subsequent awakening remains unknown. In this study, we report an anxious state results in delayed awakening in anxiety model mice from sevoflurane general anesthesia. More profound inhibition of DA neurons in the VTA contributes to delayed awakening. Optogenetic stimulation of VTA DA neurons can reverse the delay. The results indicate that VTA DA neurons may be involved in the delay in awakening from general anesthesia caused by anxiety.
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18
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Kakar E, Billar RJ, van Rosmalen J, Klimek M, Takkenberg JJM, Jeekel J. Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis. Open Heart 2021; 8:openhrt-2020-001474. [PMID: 33495383 PMCID: PMC7839877 DOI: 10.1136/openhrt-2020-001474] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/26/2020] [Accepted: 12/01/2020] [Indexed: 12/18/2022] Open
Abstract
Objectives Previous studies have reported beneficial effects of perioperative music on patients’ anxiety and pain. We performed a systematic review and meta-analysis of randomised controlled trials investigating music interventions in cardiac surgery. Methods Five electronic databases were systematically searched. Primary outcomes were patients’ postoperative anxiety and pain. Secondary outcomes were hospital length of stay, opioid use, vital parameters and time on mechanical ventilation. PRISMA guidelines were followed and PROSPERO database registration was completed (CRD42020149733). A meta-analysis was performed using random effects models and pooled standardised mean differences (SMD) with 95% confidence intervals were calculated. Results Twenty studies were included for qualitative analysis (1169 patients) and 16 (987 patients) for meta-analysis. The first postoperative music session was associated with significantly reduced postoperative anxiety (SMD = –0.50 (95% CI –0.67 to –0.32), p<0.01) and pain (SMD = –0.51 (95% CI –0.84 to –0.19), p<0.01). This is equal to a reduction of 4.00 points (95% CI 2.56 to 5.36) and 1.05 points (95% CI 0.67 to 1.41) on the State-Trait Anxiety Inventory and Visual Analogue Scale (VAS)/Numeric Rating Scale (NRS), respectively, for anxiety, and 1.26 points (95% CI 0.47 to 2.07) on the VAS/NRS for pain. Multiple days of music intervention reduced anxiety until 8 days postoperatively (SMD = –0.39 (95% CI –0.64 to –0.15), p<0.01). Conclusions Offering recorded music is associated with a significant reduction in postoperative anxiety and pain in cardiac surgery. Unlike pharmacological interventions, music is without side effects so is promising in this population.
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Affiliation(s)
- Ellaha Kakar
- Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands .,Neuroscience, Erasmus MC, Rotterdam, South-Holland, The Netherlands
| | - Ryan J Billar
- Pediatric Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands
| | | | - Markus Klimek
- Anesthesiology, Erasmus MC, Rotterdam, South-Holland, Netherlands
| | - Johanna J M Takkenberg
- CardioThoracic Surgery, Erasmus University Medical Center, Rotterdam, South-Holland, Netherlands
| | - Johannes Jeekel
- Surgery, Erasmus MC, Rotterdam, South-Holland, Netherlands.,Neuroscience, Erasmus MC, Rotterdam, South-Holland, The Netherlands
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19
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Yuenyongchaiwat K, Buranapuntalug S, Pongpanit K, Kulchanarat C, Satdhabudha O. Anxiety and Depression Symptomatology Related to Inspiratory Muscle Strength and Functional Capacity in Preoperative Cardiac Surgery Patients: A Preliminary Cross-sectional Study. Indian J Psychol Med 2020; 42:549-554. [PMID: 33354081 PMCID: PMC7735231 DOI: 10.1177/0253717620930318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2020] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Kornanong Yuenyongchaiwat
- Physiotherapy Dept., Faculty of Allied Health Sciences, Thammasat University, Prathumthani, Thailand
| | - Sasipa Buranapuntalug
- Physiotherapy Dept., Faculty of Allied Health Sciences, Thammasat University, Prathumthani, Thailand
| | - Karan Pongpanit
- Physiotherapy Dept., Faculty of Allied Health Sciences, Thammasat University, Prathumthani, Thailand
| | - Chitima Kulchanarat
- Physical Therapy Center, Thammasat University Hospital, 99 Khlong Nueng, Pathum Thani, Thailand
| | - Opas Satdhabudha
- Cardiothoracic Surgery Dept., Faculty of Medicine, Thammasat University, Prathumthani, Thailand
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20
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Eisenberg MJ, Habib B, Alcaraz M, Thombs BD, Filion KB. Bright light therapy for depressive symptoms in hospitalized cardiac patients: A randomized controlled pilot trial. PLoS One 2020; 15:e0230839. [PMID: 32226019 PMCID: PMC7105123 DOI: 10.1371/journal.pone.0230839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/09/2020] [Indexed: 11/18/2022] Open
Abstract
Depression is common among cardiac patients and associated with adverse cardiovascular outcomes. Bright light therapy has emerged as a promising treatment for depressive symptoms, however it has not yet been investigated in this population. We conducted a double-blind, randomized, placebo-controlled pilot trial to assess the feasibility of a larger-scale trial testing bright light therapy for depressive symptoms in cardiac patients. Patients hospitalized for an acute coronary syndrome or undergoing cardiac surgery were randomized to either bright light (10,000 lux) or dim light placebo (500 lux) lamps for 30 minutes each day over 4 weeks, beginning in-hospital. Depression was quantified using the Patient Health Questionnaire 9 (PHQ-9) and Depression Anxiety and Stress Scales (DASS-21). The Short-Form Health Survey 36 (SF-36) was used to measure quality of life. A total of 175 patients were screened and 15 were randomized (8 treatment, 7 placebo) (8.6%) over 10 months. Despite protocol amendments which broadened the inclusion criteria, the trial was terminated early for infeasibility based on the rate of enrollment (1–2 participants/month), with 39.5% of the target sample (38 participants) enrolled. Future trials should take into account the timing of the onset of depressive symptoms in these patients, and consider a less conservative approach to eligibility as well as ways to increase the acceptability of bright light therapy in hospitalized cardiac patients. Once enrolled, our findings suggest that most participants will adhere to the assigned treatment and complete follow-up.
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Affiliation(s)
- Mark J. Eisenberg
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Division of Cardiology, Jewish General Hospital/McGill University, Montreal, QC, Canada
- * E-mail:
| | - Bettina Habib
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
| | - Maria Alcaraz
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
| | - Brett D. Thombs
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
- Departments of Psychiatry, of Psychology, and of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Kristian B. Filion
- Center for Clinical Epidemiology, Jewish General Hospital, Lady Davis Institute, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
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21
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Schaal NK, Assmann A, Rosendahl J, Mayer-Berger W, Icks A, Ullrich S, Lichtenberg A, Akhyari P, Heil M, Ennker J, Albert A. Health-related quality of life after heart surgery - Identification of high-risk patients: A cohort study. Int J Surg 2020; 76:171-177. [PMID: 32169572 DOI: 10.1016/j.ijsu.2020.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/31/2020] [Accepted: 02/28/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This cohort study evaluated factors, which have been shown to be relevant for Health-Related Quality of Live (HRQL) after cardiac surgery and investigated the combinatory impact on HRQL. Additionally, the aim was to introduce a first attempt to developing a risk estimation model which could identify patients at risk for impaired HRQL. METHODS For this single-centre cohort study, 6099 cardiac surgical patients (60% isolated coronary bypass surgery) filled in the Nottingham Health Profile (NHP) for the evaluation of HRQL six months after surgery and provided information regarding their medical and socio-demographic status. For the NHP scores the deviation to the matched normative data of a healthy sample was calculated. A robust linear regression examined factors that influence HRQL. As a next step, based on the regression model, a risk estimation model was developed which is a first attempt to classify patients into risk categories. RESULTS Male gender, age below 60 or between 60 and 74 years, living alone, no occupation, bypass surgery, NYHA status II, III or IV and chest pain were identified as risk factors to determine impaired HRQL. The model explains 29.13% of the variance. Based on the risk estimation model 27.4% were classified as medium or high risk. CONCLUSIONS For the first time a multilevel method was applied to evaluate HRQL after heart surgery showing that socio-demographic variables are important co-factors to dyspnea and chest pain. We take a first attempt in developing a new approach that should encourage further research in this field to frame a screening tool that may help identifying patients at risk in the future.
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Affiliation(s)
- Nora K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Alexander Assmann
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Jenny Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Artur Lichtenberg
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Martin Heil
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jürgen Ennker
- Department of Cardiac Surgery, HELIOS Klinik, Krefeld, Germany; University of Witten-Herdecke, Witten, Germany
| | - Alexander Albert
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany; Department of Cardiovascular Surgery Klinikum Dortmund GGmbH, Dortmund, Germany
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22
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An international comparison of treatment and short-term overall survival for older patients with pancreatic cancer. J Geriatr Oncol 2019; 10:584-590. [DOI: 10.1016/j.jgo.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/29/2018] [Accepted: 02/11/2019] [Indexed: 12/25/2022]
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23
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Borrell-Vega J, Esparza Gutierrez AG, Humeidan ML. Multimodal Prehabilitation Programs for Older Surgical Patients. Anesthesiol Clin 2019; 37:437-452. [PMID: 31337477 DOI: 10.1016/j.anclin.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Despite advances in perioperative care, short-term and long-term postoperative complications are still experienced by many patients, which is of special relevance to the older adult population, considered to be high-risk surgical candidates because of less functional reserve and comorbidity burden. Through the implementation of prehabilitation programs, patients can be optimized to handle the physical and mental stress of surgery. Benefits have been described in a variety of surgical populations, but more studies targeting older surgical patients are needed. These studies should include standardized prehabilitation protocols and large sample sizes to avoid the limitations of the existing prehabilitation literature.
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Affiliation(s)
- Jaume Borrell-Vega
- Department of Anesthesiology - Clinical Research, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA.
| | - Alan G Esparza Gutierrez
- Department of Anesthesiology - Clinical Research, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA
| | - Michelle L Humeidan
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, N-411 Doan Hall, Columbus, OH 43210, USA
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24
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Wongkongkam K, Thosingha O, Ruangsetakit C, Phuntep K, Tonklai S. Psychological factors associated with functional recovery among patients with a peripheral arterial disease after lower extremity bypass. JOURNAL OF VASCULAR NURSING 2019; 37:3-10. [DOI: 10.1016/j.jvn.2018.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/11/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
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25
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Levett DZH, Grimmett C. Psychological factors, prehabilitation and surgical outcomes: evidence and future directions. Anaesthesia 2019; 74 Suppl 1:36-42. [DOI: 10.1111/anae.14507] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 12/23/2022]
Affiliation(s)
- D. Z. H. Levett
- Anaesthesia and Critical Care Research Area; Southampton NIHR Biomedical Research Centre; University Hospital Southampton NHS Foundation Trust; Southampton UK
- Clinical and Experimental Sciences; Faculty of Medicine; University of Southampton; Southampton UK
| | - C. Grimmett
- School of Health Sciences; University of Southampton; Southampton UK
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26
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van Dam van Isselt EF, van Wijngaarden J, Lok DJA, Achterberg WP. Geriatric rehabilitation in older patients with cardiovascular disease: a feasibility study. Eur Geriatr Med 2018; 9:853-861. [PMID: 30546796 PMCID: PMC6267640 DOI: 10.1007/s41999-018-0119-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 10/04/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE Cardiac rehabilitation in older patients after hospitalization because of cardiovascular disease is recommended. However, many older patients do not receive cardiac rehabilitation in daily practice, due to lack of referral and poor adherence. This can be related to impaired clinical and functional status of these patients, who are more likely to present with frailty, frequent comorbidities, and disability. Geriatric rehabilitation might be a possible solution to reduce barriers to cardiac rehabilitation attendance. We developed and implemented an inpatient geriatric rehabilitation programme that was provided immediately after discharge from the hospital, for older patients with a significant functional decline during hospital admission because of cardiovascular disease: 'the GR-cardio programme'. The primary aim of the present study is to investigate feasibility of the GR-cardio programme. METHODS This is a retrospective real-life feasibility study describing a consecutive series of older patients receiving the GR-cardio programme, with no control group. All patients had been hospitalized because of cardiovascular disease. Data on patient characteristics, functional status, health-related quality of life (HRQoL), readmissions, and mortality were collected from the patients file on admission, at discharge and 6 months after discharge from the GR-cardio programme. Feasibility of the programme was evaluated using the following outcomes: recruitment, resulting sample characteristics, safety, and preliminary evaluation of patients' responses to the GR-cardio programme. RESULTS In total, 58 patients [mean age 78.8 (± 9.8) years; 43% male] were included in the study. On admission, functional status and HRQoL were severely impaired but showed clinically relevant improvements. During the programme, three patients died. Eighty-three percent of all patients were discharged back home after completing the rehabilitation programme with a mean length of 38 days. Mortality rate during follow-up was the highest in patients with heart failure (32%). CONCLUSIONS This study indicates that geriatric rehabilitation for patients with cardiovascular disease is feasible. Furthermore, our results show that the GR-cardio programme can probably offer substantial benefits for patients in terms of improving functional status and HRQoL.
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Affiliation(s)
- Eléonore F van Dam van Isselt
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands.
- Zorggroep Solis, Deventer, The Netherlands.
| | | | - Dirk J A Lok
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, The Netherlands
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Bagheri H, Ebrahimi H, Abbasi A, Atashsokhan G, Salmani Z, Zamani M. Effectiveness of Preoperative Visitation on Postanesthesia Complications. J Perianesth Nurs 2018; 33:651-657. [PMID: 30236572 DOI: 10.1016/j.jopan.2017.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/22/2017] [Accepted: 05/09/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of preoperative visitation on postanesthesia complications after hernia surgery. DESIGN In this quasi-experimental study, 70 patients receiving elective hernia surgery were purposefully selected. METHODS In the evening preceding surgery, the surgical technologist visited the patient in the surgical ward. Data were collected by checklist of vital signs and postanesthesia complications. FINDINGS A greater increase is observed in the systolic blood pressure of the experimental group at the moment of entering the postanesthesia care unit. A significant difference was found between groups in the intensity of postanesthesia agitation in the postanesthesia care unit patients, with a higher incidence among the experimental group. CONCLUSIONS According to the findings, preoperative education programs for operating room staff and other behavioral and mental interventions to manage surgery and its consequences in elective surgical patients is recommended.
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Psychosocial Factors and Surgical Outcomes in Adult Spinal Deformity: Do Dementia Patients Have More Complications? Spine (Phila Pa 1976) 2018; 43:1038-1043. [PMID: 29227363 DOI: 10.1097/brs.0000000000002517] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of a prospectively collected, national inpatient hospital database. OBJECTIVE We aimed to investigate comorbid psychiatric disorders in the adult spinal deformity (ASD) population. We hypothesized that a high incidence of comorbid psychiatric disorders in ASD would negatively impact perioperative outcomes. SUMMARY OF BACKGROUND DATA Patients with adult spinal fusion (ASF) suffer from severe back pain and often depression. Psychiatric comorbidities in the ASD population are not well understood, despite the apparent psychological effects of spinal deformity-related self-image. METHODS The Nationwide Inpatient Sample databases from 2001 to 2009 were queried for patients ages 18 years or older with in-hospital stays including a spine arthrodesis. Patients were divided into two groups: ASD (diagnosis of scoliosis, excluding neuromuscular and congenital) and all other ASF. Subjects were further stratified by presence of a comorbid psychiatric diagnosis. Differences between each surgical group in psychiatric frequency and complications were calculated using analysis of variance, adjusted for operative complexity. A binary logistic regression analyzed the association between psychiatric diagnoses and likelihood of complications. RESULTS A total of 3,366,352 ASF and 219,975 ASD patients were identified. The rate of comorbid psychiatric diagnoses in ASD was significantly higher (23.5%) compared to ASF patients (19.4%, P < 0.001). Complication rates were higher for ASD compared to ASF; patients without a psychiatric diagnosis had lower (or comparable) complication rates than psychiatric patients, across all disorder categories. Patients with psychotic disorders and dementia showed more complications than controls; patients with mood, anxiety and alcohol disorders showed fewer. CONCLUSION Psychiatric comorbidities are more common in the ASD population than in adult fusion patients. ASD and ASF patients with the most common psychiatric disorders (mood, anxiety, and alcohol abuse) are not at increased risk for complications compared to controls. Those patients with psychotic disorders and dementia are at a significant risk for increased complications and surgeons should be aware of these specific risks. LEVEL OF EVIDENCE 2.
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Arora RC, Brown CH, Sanjanwala RM, McKelvie R. “NEW” Prehabilitation: A 3-Way Approach to Improve Postoperative Survival and Health-Related Quality of Life in Cardiac Surgery Patients. Can J Cardiol 2018; 34:839-849. [DOI: 10.1016/j.cjca.2018.03.020] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 03/16/2018] [Accepted: 03/28/2018] [Indexed: 01/03/2023] Open
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Abbaszadeh Y, Allahbakhshian A, Seyyedrasooli A, Sarbakhsh P, Goljarian S, Safaei N. Effects of foot reflexology on anxiety and physiological parameters in patients undergoing coronary artery bypass graft surgery: A clinical trial. Complement Ther Clin Pract 2018; 31:220-228. [DOI: 10.1016/j.ctcp.2018.02.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/25/2018] [Accepted: 02/28/2018] [Indexed: 11/16/2022]
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Neff C, Totten C, Plymale M, Oyler DR, Davenport D, Roth JS. Associations between anxiolytic medications and ventral hernia repair. Hernia 2018; 22:753-757. [PMID: 29594842 DOI: 10.1007/s10029-018-1766-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/23/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examines the relationship between anxiolytic medications (AXM) on outcomes following ventral hernia repair. METHODS A single-center review of prospectively obtained perioperative and 30-day outcome data, including AXM use at admission, as part of the National Surgery Quality Improvement Program. RESULTS Sixty-three of the 393 patients who presented for ventral hernia repair were taking an AXM (15.6%). AXM users were more likely to have a higher ASA class, dyspnea, and treated hypertension (p < 0.05). AXM use was associated with increased operative duration, hernia size, increased estimated blood loss, and need for component separation. After adjusting for medical comorbidities, AXM users were not found to have greater 30-day morbidity or mortality. Patients taking AXM were found to have greater length of stay and increased hospital readmissions. CONCLUSIONS Patients taking anxiolytic medications undergoing ventral hernia repairs have higher ASA scores, more complex hernia characteristics, and require more concurrent procedures. They were found to have longer operative times, increased blood loss, greater duration of hospital stay, and increased readmissions that were associated with the increased perioperative risk factors. Further studies are required to determine causal links.
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Affiliation(s)
- C Neff
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - C Totten
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - M Plymale
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA.
| | - D R Oyler
- Department of Pharmacy, University of Kentucky HealthCare, 800 Rose Street, Lexington, KY, 40536, USA
| | - D Davenport
- Department of Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
| | - J S Roth
- Division of General Surgery, University of Kentucky College of Medicine, C 225, 800 Rose Street, Lexington, KY, 40536, USA
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Heidari F, Rejeh N, Heravi-Karimooi M, Tadrisi SD, Vaismoradi M. Effect of short-term hand reflexology on anxiety in patients before coronary angiography: A randomized placebo controlled trial. Eur J Integr Med 2017. [DOI: 10.1016/j.eujim.2017.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Moazen-Zadeh E, Abbasi SH, Safi-Aghdam H, Shahmansouri N, Arjmandi-Beglar A, Hajhosseinn Talasaz A, Salehiomran A, Forghani S, Akhondzadeh S. Effects of Saffron on Cognition, Anxiety, and Depression in Patients Undergoing Coronary Artery Bypass Grafting: A Randomized Double-Blind Placebo-Controlled Trial. J Altern Complement Med 2017; 24:361-368. [PMID: 29185780 DOI: 10.1089/acm.2017.0173] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Cognitive decline, depression, and anxiety are among the major concerns in patients undergoing coronary artery bypass grafting (CABG). Crocus sativus L. (saffron) seems to be a promising candidate for treatment of these conditions. DESIGN In this 12-week, randomized, double-blind, placebo-controlled clinical trial, men and women with on-pump CABG, who had Wechsler Memory Scale (WMS) score >70 and age <70 years, received either saffron capsules (15 mg/twice daily) or placebo. Patients were excluded if they had history of treatment with saffron or acetylcholinesterase inhibitors, comorbid neuropsychiatric disorders, serious medical conditions other than cardiovascular diseases, and hypersensitivity to herbal compounds. The primary outcome was defined as the difference in mean total score changes for WMS-Revised from the baseline to week 12 between the saffron and placebo groups. Secondary outcomes included difference in mean score changes from baseline to endpoint between the two treatment groups for Mini Mental Status Examination and subscales of Hospital Anxiety and Depression Scale ( www.irct.ir ; IRCT201408071556N63). RESULTS No significant difference was detected in primary or secondary outcomes between the saffron and placebo groups. Also, no significant time × treatment interaction effect was found for any of the scales. CONCLUSIONS The results of this trial do not support the hypothesis of potential benefits of saffron in treatment of CABG-related neuropsychiatric conditions.
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Affiliation(s)
- Ehsan Moazen-Zadeh
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences , Tehran, Iran
| | | | - Hamideh Safi-Aghdam
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences , Tehran, Iran
| | | | | | | | - Abbas Salehiomran
- 2 Tehran Heart Center, Tehran University of Medical Sciences , Tehran, Iran
| | | | - Shahin Akhondzadeh
- 1 Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences , Tehran, Iran
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Aspari AR, Lakshman K. Effects of Pre-operative Psychological Status on Post-operative Recovery: A Prospective Study. World J Surg 2017; 42:12-18. [DOI: 10.1007/s00268-017-4169-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Ziehm S, Rosendahl J, Barth J, Strauss BM, Mehnert A, Koranyi S. Psychological interventions for acute pain after open heart surgery. Cochrane Database Syst Rev 2017; 7:CD009984. [PMID: 28701028 PMCID: PMC6432747 DOI: 10.1002/14651858.cd009984.pub3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND This is an update of a Cochrane review previously published in 2014. Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences. Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. OBJECTIVES To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention control in adults undergoing open heart surgery for pain, pain medication, psychological distress, mobility, and time to extubation. SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, and PsycINFO for eligible studies up to February 2017. We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We checked lists of references of relevant articles and previous reviews. We searched the ProQuest Dissertations and Theses Full Text Database, ClinicalTrials and the WHO International Clinical Trials Registry Platform to identify any unpublished material or ongoing trials. We also contacted the authors of primary studies to identify any unpublished material. In addition, we wrote to all leading heart centres in Germany, Switzerland, and Austria to check whether they were aware of any ongoing trials. SELECTION CRITERIA Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. DATA COLLECTION AND ANALYSIS Two review authors (SZ and SK) independently assessed trials for eligibility, estimated the risk of bias and extracted all data. We calculated effect sizes for each comparison (Hedges' g) and meta-analysed data using a random-effects model. We assessed the evidence using GRADE and created 'Summary of findings' tables. MAIN RESULTS We added six studies to this update. Overall, we included 23 studies (2669 participants).For the majority of outcomes (two-thirds), we could not perform a meta-analysis since outcomes were not measured, or data were provided by one trial only.No study reported data on the number of participants with pain intensity reduction of at least 50% from baseline. Only one study reported data on the number of participants below 30/100 mm on the Visual Analogue Scale (VAS) in pain intensity (very low-quality evidence). Psychological interventions did not reduce pain intensity in the short-term interval (g 0.39, 95% CI -0.18 to 0.96, 2 studies, 104 participants, low-quality evidence), medium-term interval (g -0.02, 95% CI -0.24 to 0.20, 4 studies, 413 participants, moderate-quality evidence) or in the long-term interval (g 0.05, 95% CI -0.20 to 0.30, 2 studies, 200 participants, moderate-quality evidence).No study reported data on median time to re-medication or on number of participants re-medicated. Only two studies provided data on postoperative analgesic use in the short-term interval, showing that psychological interventions did not reduce the use of analgesic medication (g 1.18, 95% CI -2.03 to 4.39, 2 studies, 104 participants, low-quality evidence). Studies revealed that psychological interventions reduced mental distress in the medium-term (g 0.37, 95% CI 0.13 to 0.60, 13 studies, 1388 participants, moderate-quality evidence) and likewise in the long-term interval (g 0.32, 95% CI 0.10 to 0.53, 14 studies, 1586 participants, moderate-quality evidence). Psychological interventions did not improve mobility in the medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444 participants, low-quality evidence), nor in the long-term interval (g 0.09, 95% CI -0.10 to 0.28, 4 studies, 458 participants, moderate-quality evidence). Only two studies reported data on time to extubation, indicating that psychological interventions reduced the time to extubation (g 0.56, 95% CI 0.08 to 1.03, 2 studies, 154 participants, low-quality evidence).Overall, the very low to moderate quality of the body of evidence on the efficacy of psychological interventions for acute pain after open heart surgery cannot be regarded as sufficient to draw robust conclusions.Most 'Risk of bias' assessments were low or unclear. We judged selection bias (random sequence generation) and attrition bias to be mostly low risk for included studies. However, we judged the risk of selection bias (allocation concealment), performance bias, detection bias and reporting bias to be mostly unclear. AUTHORS' CONCLUSIONS In line with the conclusions of our previous review, there is a lack of evidence to support or refute psychological interventions in order to reduce postoperative pain in participants undergoing open heart surgery. We found moderate-quality evidence that psychological interventions reduced mental distress in participants undergoing open heart surgery. Given the small numbers of studies, it is not possible to draw robust conclusions on the efficacy of psychological interventions on outcomes such as analgesic use, mobility, and time to extubation respectively on adverse events or harms of psychological interventions.
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Affiliation(s)
- Susanne Ziehm
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
| | - Jenny Rosendahl
- University Hospital of JenaInstitute of Psychosocial Medicine and PsychotherapyStoystrasse 3JenaThuringiaGermany07743
| | - Jürgen Barth
- UniversityHospital and University of ZurichInstitute for Complementary and Integrative MedicineSonneggstrasse 6ZurichSwitzerlandCH‐8091
| | - Bernhard M Strauss
- University Hospital of JenaInstitute of Psychosocial Medicine and PsychotherapyStoystrasse 3JenaThuringiaGermany07743
| | - Anja Mehnert
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
| | - Susan Koranyi
- University Hospital of LeipzigInstitute of Medical Psychology and Medical SoziologyPhilipp‐Rosenthal‐Straße 55LeipzigSaxonyGermany4103
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Dadgostar A, Bigder M, Punjani N, Lozo S, Chahal V, Kavanagh A. Does preoperative depression predict post-operative surgical pain: A systematic review. Int J Surg 2017; 41:162-173. [DOI: 10.1016/j.ijsu.2017.03.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/21/2017] [Accepted: 03/22/2017] [Indexed: 02/06/2023]
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Shaughness G, Howard R, Englesbe M. Patient-centered surgical prehabilitation. Am J Surg 2017; 216:636-638. [PMID: 28456341 DOI: 10.1016/j.amjsurg.2017.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 01/12/2023]
Affiliation(s)
| | - Ryan Howard
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA
| | - Michael Englesbe
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI, USA.
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Kidd T, Poole L, Ronaldson A, Leigh E, Jahangiri M, Steptoe A. Attachment anxiety predicts depression and anxiety symptoms following coronary artery bypass graft surgery. Br J Health Psychol 2016; 21:796-811. [PMID: 26999442 PMCID: PMC5082502 DOI: 10.1111/bjhp.12191] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/27/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Depression and anxiety are associated with poor recovery in coronary artery bypass graft (CABG) patients, but little is known about predictors of depression and anxiety symptoms. DESIGN We tested the prospective association between attachment orientation, and symptoms of depression and anxiety in CABG patients, 6-8 weeks, and 12 months following surgery. METHOD One hundred and fifty-five patients who were undergoing planned CABG surgery were recruited. Patients completed questionnaires measuring attachment, depression, and anxiety prior to surgery, then 6-8 weeks, and 12 months after surgery. RESULTS Attachment anxiety predicted symptoms of depression and anxiety at both follow-up time points, whereas attachment avoidance was not associated with depression or anxiety symptoms. The findings remained significant when controlling for baseline mood scores, social support, demographic, and clinical risk factors. CONCLUSION These results suggest that attachment anxiety is associated with short-term and long-term depression and anxiety symptoms following CABG surgery. These results may offer important insight into understanding the recovery process in CABG surgery. Statement of contribution What is already known on this subject? Depression and anxiety symptoms are twice more likely to occur in coronary artery bypass graft (CABG) populations than in any other medical group. Depression and anxiety are associated with poor recovery following cardiac surgery. Predictors of depression and anxiety in CABG patients have been underexplored. What does this study add? This study highlights the importance of close interpersonal relationships on health. Attachment anxiety was prospectively associated with higher levels of depression and anxiety. These results add to understanding mechanisms linked to recovery following CABG.
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Affiliation(s)
- Tara Kidd
- Department of Epidemiology and Public Health, University College London, UK
| | - Lydia Poole
- Department of Epidemiology and Public Health, University College London, UK.
| | - Amy Ronaldson
- Department of Epidemiology and Public Health, University College London, UK
| | - Elizabeth Leigh
- Department of Epidemiology and Public Health, University College London, UK
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St. George's Hospital, University of London, UK
| | - Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, UK
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Shoar S, Naderan M, Aghajani M, Sahimi-Izadian E, Hosseini-Araghi N, Khorgami Z. Prevalence and Determinants of Depression and Anxiety Symptoms in Surgical Patients. Oman Med J 2016; 31:176-81. [PMID: 27162587 DOI: 10.5001/omj.2016.35] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Mood disorders are prevalent in hospitalized patients. However, risk factors for early diagnosis have not been studied exclusively in surgical patients. Our study aimed to investigate the prevalence and determinants of depression and anxiety symptoms in surgical patients. METHODS We included 392 surgical patients in this prospective cross-sectional study, which took place between June 2011 and June 2012. The Hospital Anxiety and Depression Scale (HADS) was used to screen for symptoms of depression and anxiety at weekly interviews. Regression analysis was performed to identify risk factors for early (the day after admission) and late (one week or more) in-hospital psychiatry symptoms. RESULTS Depression and anxiety symptoms increased from the time of admission toward longer hospital stay. Scores obtained in the second and third weeks of admission were associated with the need for surgery while HADS in the third week was associated with lack of familial support and being under the poverty line (p < 0.050). Regression model analysis showed that early depression was associated with female gender, and early anxiety was inversely affected by female gender and protected by higher education level. A history of mood disorder was a risk factor. Later anxiety was also associated with longer hospital stay. CONCLUSIONS Depression and anxiety symptoms are a major concern in surgical patients especially in females and those with a history of mood disorders or lower educational level. Patients with a longer hospital stay, in particular, those with underlying diseases, postoperative complications, lack of familial support, and the need for reoperation were also at increased risk.
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Affiliation(s)
- Saeed Shoar
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Naderan
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Motahareh Aghajani
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Elaheh Sahimi-Izadian
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Hosseini-Araghi
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhamak Khorgami
- Department of Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Improvement of Surgical Outcomes and Procedures, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Patron E, Messerotti Benvenuti S, Palomba D. Preoperative biomedical risk and depressive symptoms are differently associated with reduced health-related quality of life in patients 1year after cardiac surgery. Gen Hosp Psychiatry 2016; 40:47-54. [PMID: 26947593 DOI: 10.1016/j.genhosppsych.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/04/2016] [Accepted: 02/06/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine whether preoperative biomedical risk and depressive symptoms were associated with physical and mental components of health-related quality of life (HRQoL) in patients 1year after cardiac surgery. METHOD Seventy-five patients completed a psychological evaluation, including the Center for Epidemiological Study of Depression scale, the 12-item Short-Form Physical Component Scale (SF-12-PCS) and Mental Component Scale (SF-12-MCS), the Instrumental Activities of Daily Living questionnaire for depressive symptoms and HRQoL, respectively, before surgery and at 1-year follow-up. RESULTS Preoperative depressive symptoms predicted the SF-12-PCS (beta=-.22, P<.05) and SF-12-MCS (beta=-.30, P<.04) scores in patients 1year after cardiac surgery, whereas the European System for Cardiac Operative Risk Evaluation was associated with SF-12-PCS (beta=-.28, P<.02), but not SF-12-MCS (beta=.01, P=.97) scores postoperatively. CONCLUSIONS The current findings showed that preoperative depressive symptoms are associated with poor physical and mental components of HRQoL, whereas high biomedical risk predicts reduced physical, but not mental, functioning in patients postoperatively. This study suggests that a preoperative assessment of depressive symptoms in addition to the evaluation of common biomedical risk factors is essential to anticipate which patients are likely to show poor HRQoL after cardiac surgery.
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Affiliation(s)
- Elisabetta Patron
- Department of General Psychology, University of Padova, Via Venezia, 8-35131, Padova, Italy.
| | | | - Daniela Palomba
- Department of General Psychology, University of Padova, Via Venezia, 8-35131, Padova, Italy.
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Beresnevaitė M, Benetis R, Taylor GJ, Rašinskienė S, Stankus A, Kinduris S. Impact of a Cognitive Behavioral Intervention on Health-Related Quality of Life and General Heart Rate Variability in Patients Following Cardiac Surgery: An Effectiveness Study. PSYCHOSOMATICS 2016; 57:605-615. [PMID: 27452635 DOI: 10.1016/j.psym.2016.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/16/2016] [Accepted: 04/19/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although there is evidence supporting the efficacy of cognitive-behavioral therapy (CBT) in decreasing psychologic symptoms and improving health-related quality of life in patients who have undergone coronary artery bypass graft surgery, the effectiveness of these interventions in usual health care practice, and their effect on general heart rate variability (HRV), has not been tested. OBJECTIVE This study investigated the effectiveness of CBT in improving health-related quality of life and HRV in patients with postcardiac surgery. METHODS However, 2 months following surgery, 150 patients were assigned sequentially to a CBT group that received the intervention for 9 months or a comparison group that received usual care. Patients were assessed at baseline and after 10 months with the 36-item Short Form Health Survey. HRV was also assessed. RESULTS In total, 43 patients in the CBT group and 46 in the usual care group completed the study. The CBT group demonstrated significant improvements in health-related quality of life and significant increases in general HRV. Significant group-by-time interaction effects were found for the several 36-item Short Form Health Survey scales and mental component summary and a time-domain HRV parameter indicating that the pattern of change in scores over time differed significantly between the 2 groups. CONCLUSION CBT administered in a "real-world" clinical setting can effectively improve health-related quality of life and the general HRV in patients who have undergone cardiac surgery.
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Affiliation(s)
- Margarita Beresnevaitė
- Laboratory of Clinical Cardiology, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Rimantas Benetis
- Laboratory of Clinical Cardiology, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Graeme J Taylor
- Department of Psychiatry, University of Toronto and Mount Sinai Hospital, Toronto, Canada
| | | | - Albinas Stankus
- Faculty of Medicine, Klaipeda University, Klaipeda, Lithuania
| | - Sarunas Kinduris
- Laboratory of Clinical Cardiology, Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Pretreatment of Depression Before Cervical Spine Surgery Improves Patients' Perception of Postoperative Health Status: A Retrospective, Single Institutional Experience. World Neurosurg 2016; 87:214-9. [DOI: 10.1016/j.wneu.2015.11.067] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/14/2015] [Accepted: 11/19/2015] [Indexed: 11/19/2022]
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Ward N, Roth JS, Lester CC, Mutiso L, Lommel KM, Davenport DL. Anxiolytic medication is an independent risk factor for 30-day morbidity or mortality after surgery. Surgery 2015; 158:420-7. [DOI: 10.1016/j.surg.2015.03.050] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 01/04/2023]
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44
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Geriatric consultation. Int Anesthesiol Clin 2015; 52:14-25. [PMID: 25268861 DOI: 10.1097/aia.0000000000000029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Effect of Anxiety on Individuals and Caregivers After Coronary Artery Bypass Grafting Surgery. Dimens Crit Care Nurs 2015; 34:285-8. [DOI: 10.1097/dcc.0000000000000137] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Guo P. Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: a review of randomised controlled trials. J Clin Nurs 2014; 24:34-46. [PMID: 24894181 DOI: 10.1111/jocn.12618] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2014] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To update evidence of the effectiveness of preoperative education among cardiac surgery patients. BACKGROUND Patients awaiting cardiac surgery may experience high levels of anxiety and depression, which can adversely affect their existing disease and surgery and result in prolonged recovery. There is evidence that preoperative education interventions can lead to improved patient experiences and positive postoperative outcomes among a mix of general surgical patients. However, a previous review suggested limited evidence to support the positive impact of preoperative education on patients' recovery from cardiac surgery. DESIGN Comprehensive review of the literature. METHODS The Cochrane Central Register of Controlled Trials from the Cochrane Library, MEDLINE, CINAHL, PsycINFO, EMBASE and Web of Science were searched for English-language articles published between 2000-2011. Original articles were included reporting randomised controlled trials of cardiac preoperative education interventions. RESULTS Six trials were identified and have produced conflicting findings. Some trials have demonstrated the effects of preoperative education on improving physical and psychosocial recovery of cardiac patients, while others found no evidence that patients' anxiety is reduced or of any effect on pain or hospital stay. CONCLUSION Evidence of the effectiveness of preoperative education interventions among cardiac surgery patients remains inconclusive. Further research is needed to evaluate cardiac preoperative education interventions for sustained effect and in non-Western countries. RELEVANCE TO CLINICAL PRACTICE A nurse-coordinated multidisciplinary preoperative education approach may offer a way forward to provide a more effective and efficient service. Staff training in developing and delivering such interventions is a priority.
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Affiliation(s)
- Ping Guo
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK; The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan, China
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Guo P, East L, Arthur A. Thinking outside the black box: the importance of context in understanding the impact of a preoperative education nursing intervention among Chinese cardiac patients. PATIENT EDUCATION AND COUNSELING 2014; 95:365-370. [PMID: 24666774 DOI: 10.1016/j.pec.2014.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 02/19/2014] [Accepted: 03/02/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE In a randomized controlled trial of a preoperative education intervention conducted for Chinese cardiac patients, we observed a greater effect on symptoms of anxiety and depression than that reported with regard to similar interventions in western care settings. The objective of this qualitative study was to help explain the findings of the trial by exploring Chinese patients' experience of seeking and receiving information before cardiac surgery. METHODS Semi-structured interviews were conducted with a purposive sample of 20 trial participants before discharge (ten from the preoperative education group; ten from the usual care control group). Data were analyzed using a thematic analysis approach. RESULTS A total of five themes were generated: the role of reputation and hierarchy; gaining strength from knowledge; information as a low priority; being kept in the dark; and learning through peer support. CONCLUSION In health care systems where service users are given relatively little information, interventions designed to inform patients about their treatment are likely to have a much greater impact on their psychological health. PRACTICE IMPLICATIONS Providers of services for patients undergoing cardiac surgery in China should be encouraged to incorporate information giving into routine practice, tailored according to individual need.
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Affiliation(s)
- Ping Guo
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, UK; The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
| | - Linda East
- School of Health Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, UK
| | - Antony Arthur
- School of Nursing Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, UK
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Koranyi S, Barth J, Trelle S, Strauss BM, Rosendahl J. Psychological interventions for acute pain after open heart surgery. Cochrane Database Syst Rev 2014:CD009984. [PMID: 24861376 DOI: 10.1002/14651858.cd009984.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Acute postoperative pain is one of the most disturbing complaints in open heart surgery, and is associated with a risk of negative consequences. Several trials investigated the effects of psychological interventions to reduce acute postoperative pain and improve the course of physical and psychological recovery of participants undergoing open heart surgery. OBJECTIVES To compare the efficacy of psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery on pain, pain medication, mental distress, mobility, and time to extubation. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 8), MEDLINE (1946 to September 2013), EMBASE (1980 to September 2013), Web of Science (all years to September 2013), and PsycINFO (all years to September 2013) for eligible studies. We used the 'related articles' and 'cited by' options of eligible studies to identify additional relevant studies. We also checked lists of references of relevant articles and previous reviews. We also searched the ProQuest Dissertations and Theses Full Text Database (all years to September 2013) and contacted the authors of primary studies to identify any unpublished material. SELECTION CRITERIA Randomised controlled trials comparing psychological interventions as an adjunct to standard care versus standard care alone or standard care plus attention in adults undergoing open heart surgery. DATA COLLECTION AND ANALYSIS Two review authors (SK and JR) independently assessed trials for eligibility, estimated the risk of bias and extracted all data. We calculated effect sizes for each comparison (Hedges' g) and meta-analysed data using a random-effects model. MAIN RESULTS Nineteen trials were included (2164 participants).No study reported data on the number of participants with pain intensity reduction of at least 50% from baseline. Only one study reported data on the number of participants below 30/100 mm on the Visual Analogue Scale (VAS) in pain intensity. Psychological interventions have no beneficial effects in reducing pain intensity measured with continuous scales in the medium-term interval (g -0.02, 95% CI -0.24 to 0.20, 4 studies, 413 participants, moderate quality evidence) nor in the long-term interval (g 0.12, 95% CI -0.09 to 0.33, 3 studies, 280 participants, low quality evidence).No study reported data on median time to remedication or on number of participants remedicated. Only one study provided data on postoperative analgesic use. Studies reporting data on mental distress in the medium-term interval revealed a small beneficial effect of psychological interventions (g 0.36, 95% CI 0.10 to 0.62, 12 studies, 1144 participants, low quality evidence). Likewise, a small beneficial effect of psychological interventions on mental distress was obtained in the long-term interval (g 0.28, 95% CI 0.05 to 0.51, 11 studies, 1320 participants, low quality evidence). There were no beneficial effects of psychological interventions on mobility in the medium-term interval (g 0.23, 95% CI -0.22 to 0.67, 3 studies, 444 participants, low quality evidence) nor in the long-term interval (g 0.29, 95% CI -0.14 to 0.71, 4 studies, 423 participants, low quality evidence). Only one study reported data on time to extubation. AUTHORS' CONCLUSIONS For the majority of outcomes (two-thirds) we could not perform a meta-analysis since outcomes were not measured, or data were provided by one trial only. Psychological interventions have no beneficial effects on reducing postoperative pain intensity or enhancing mobility. There is low quality evidence that psychological interventions reduce postoperative mental distress. Due to limitations in methodological quality, a small number of studies, and large heterogeneity, we rated the quality of the body of evidence as low. Future trials should measure crucial outcomes (e.g. number of participants with pain intensity reduction of at least 50% from baseline) and should focus to enhance the quality of the body of evidence in general. Altogether, the current evidence does not clearly support the use of psychological interventions to reduce pain in participants undergoing open heart surgery.
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Affiliation(s)
- Susan Koranyi
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital of Jena, Stoystrasse 3, Jena, Thuringia, Germany, 07743
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