Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity

Do Extended Reality Interventions Benefit Patients Undergoing Elective Cardiac Surgical and Interventional Procedures? A Systematic Review and Meta-analysis

BACKGROUND

Extended reality (XR) interventions have the potential to benefit patients undergoing elective cardiac surgical and interventional procedures. However, there are no systematic reviews with meta-analyses to guide clinical care.

AIM

To critically evaluate the evidence on the effectiveness of XR interventions on patient anxiety and pain and other associated outcomes.

DESIGN

Systematic review and meta-analysis following the PRISMA 2020 statement.

DATA SOURCES

A systematic search of five databases (CENTRAL, CINAHL, MEDLINE, PsycInfo, Scopus) from inception to July 2023.

METHODS

Screening and data extraction was conducted independently by multiple reviewers. Stata (Version 17) was used to conduct meta-analyses for patient anxiety and pain. Secondary patient outcomes were summarised in a synthesis. The Cochrane Risk of Bias (Version 2) tool was applied to trials and the NHLBI Study Quality Assessment tools to all other study designs.

RESULTS

Of the 3372 records identified, 22 were included, 10 of which were eligible for inclusion in the meta-analyses. Fifty-seven percent of randomised trials were rated as high risk of bias. Virtual reality (VR) was the only XR technology evaluated. VR significantly reduced pre-procedural anxiety (standardised mean difference: -1.29; 95% confidence interval - 1.96, -0.62, p < 0.001), and peri-procedural anxiety (standardised mean difference: -0.50; 95% confidence interval - 0.83, -0.18, p < 0.003) but did not reduce pain levels, compared with usual care. VR increased pre-procedural knowledge and postsurgical physical and pulmonary function. VR interventions may also improve emotional wellbeing, care delivery and physiological outcomes, but evidence was inconsistent.

CONCLUSIONS

XR potentially benefits cardiac patients undergoing elective invasive procedures and surgery by reducing pre- and peri-procedural anxiety and increasing procedural knowledge and physical function.

RELEVANCE TO CLINICAL PRACTICE

Cardiac nurses' role can be supported by VR interventions to improve the patient experience and several aspects of patient care.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable as this is a systematic review.

Use of virtual reality in preoperative education of cardiac surgery patients - A feasibility study

OBJECTIVE

A Virtual Patient Tour (VPT) was developed to inform cardiac surgery patients about their hospitalization from the admission to their postoperative stay on the ward. The objective of our study was to assess the feasibility and acceptability of this VPT following the framework of the Virtual Reality Clinical Outcomes Research Experts Committee.

METHODS

In this single-centre cross-sectional study, adult patients admitted to the hospital for elective cardiac surgery were included. Acceptability, usability, and tolerability were measured by the validated questionnaires Unified Theory of Acceptance and Use of Technology (acceptability), System Usability Scale (usability), and Virtual Reality Sickness Questionnaire (tolerability). Descriptive statistics were used for the analysis.

RESULTS

Twenty-eight participants used the VPT. Results showed high acceptability (mean 16.7 ± 1.5), acceptable usability (mean 86.7 ± 9.3), and high tolerability (sickness score, median 7.1 % [0-17.1 %]).

CONCLUSION

The use of the VPT is a feasible and promising technique. The next step is to optimize the content and technique of the VPT based on the suggestions of the participants.

PRACTICE IMPLICATIONS

We recommend incorporating the VPT into preoperative patient education in addition to the routine information in cardiac surgery patients.

Evaluation of Postoperative Pain After Cardiothoracic Surgery in Patients With and Without Significant Preoperative Anxiety: A Prospective Observational Study

BACKGROUND AND AIMS

Anxiety plays a distressing role in cardiothoracic operations. It may trigger hemodynamic instability, increased morbidity, and very crucially, postoperative pain and analgesic use. Our aim is to look at the association between anxiety, postoperative pain, and analgesic use.

MATERIALS AND METHODS

One hundred and twenty-two patients scheduled for cardiothoracic surgeries were asked questions according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the evening prior to the surgery. Different factors that could affect anxiety perioperatively were recorded through the patient's hospital records. The visual analog score (VAS) was recorded at arrival in the ICU after surgery. Paracetamol (1 g) and Inj Tramadol (1 mg/kg) were administered as postoperative analgesia. Additional fentanyl boluses (1 mcg/kg) were administered whenever the VAS exceeded 4. Analgesic doses were documented. All the data were then analyzed statistically.

RESULTS

Preoperative anxiety was recorded in 63.9% of the 122 subjects included in the study, with younger patients and patients with very low socioeconomic status being the majority. VAS, at 20 and 24 hrs of assessment, was higher in both groups, and there was a statistically significant difference, with patients that were preoperatively anxious, recording higher VAS scores. Postoperative analgesic doses were also significantly higher for patients with anxiety.

CONCLUSIONS

This clinical trial demonstrated that greater than 60% of the participants presented with preoperative anxiety, the majority being young participants. Lower socioeconomic status is also a risk factor for preoperative anxiety. Patients who suffered from preoperative anxiety are more likely to have greater pain scores and analgesic needs during postsurgical assessment.

Study protocol for a cross-sectional online survey investigating patient preferences and experiences of waiting for elective cardiac surgery

INTRODUCTION

Being on a waiting list for elective (planned) cardiac surgery can be physically and psychologically challenging for patients. Research suggests that stress associated with waiting for surgery is dependent on different individual and contextual factors. However, most data on patients' experiences of waiting for surgery and preferences for waiting list management derives from non-cardiac clinical populations. The aim of the current study is to explore patients' experiences of being on a waiting list for elective cardiac surgery, and their views on how the waiting experience could be improved in the future. This work will inform the patient management strategy during the waiting period for surgery across the four major hospitals in London directly involved in this study, and potentially beyond by transferring learning to other services.

METHODS AND ANALYSIS

This is a mixed-methods study that will collect quantitative and qualitative data using a cross-sectional online survey. Patients who are on waiting lists for elective surgery across four major cardiac surgery departments in London hospitals, and are at least 18 years old, will be invited by their healthcare team via text message or letter to complete the survey. The target sample size of non-randomly selected participants will be 268. Bivariable and multivariable regression models will be used to assess associations between survey items measuring the impact of the cardiac condition on specific life domains (eg, daily activities, social and family relationships, hobbies, sexual life), anxiety and depression symptoms as measured by the Patient Health Questionnaire-4 and survey items evaluating experiences of health services. Data on experience and preferences for improvements to the waiting experience will be analysed with qualitative content analysis using an inductive approach.

ETHICS AND DISSEMINATION

This study was reviewed and granted ethical approval by the East of England-East Cambridge Research Ethics Committee. Findings from this study will be disseminated through peer-reviewed journals, a research website and social media and with an online event engaging patients, members of the public, healthcare professionals and other relevant stakeholders.

TRIAL REGISTRATION NUMB

NCT05996640.

Enhancement of Preoperative Mental Health Assessment Through Clinical Nurse Specialist Project Leadership

PURPOSE/OBJECTIVES

The aim of the project was to discern whether a collaborative, consultative-rich, clinical nurse specialist-led project could increase completion rates of a patient health questionnaire for depression and a generalized anxiety disorder questionnaire with appropriate referrals in adult patients in the ambulatory and hospital settings of a robust cardiovascular surgery practice before cardiovascular surgery.

DESCRIPTION OF PROJECT

The Define, Measure, Analyze, Improve, Control implementation methodology guided this quality improvement project. The workflow was analyzed in collaboration with stakeholders, and barriers to and facilitators of questionnaire completion were identified. Interpreter services partnerships were enhanced and used for patients with a preferred language other than English. Weekly data analysis assessed ongoing questionnaire completion rates.

OUTCOME

Documented completion rates of questionnaires improved across ambulatory and hospital settings by 15%. Patients with a preferred language other than English had an 80-percentage-point increase in documented questionnaire completion.

CONCLUSION

Clinical nurse specialists are poised to lead projects because of their use of the collaborative and consultative core competencies. A formal electronic health record report was established for monitoring outcomes. Embedding questionnaire administration within the standard workflow of ambulatory and hospital staff makes administering questionnaires preoperatively a sustainable practice in both settings.

Exploring the effect of music therapy as intervention to reduce anxiety pre- and post-operatively in CABG surgery: A quantitative systematic review

AIM

Patients undergoing coronary artery bypass graft (CABG) surgery may experience psychological complications, which can increase mortality. This review aims to explore the efficacy of music therapy as an intervention to reduce anxiety pre- and post-operatively in CABG surgery.

DESIGN

This was a quantitative systematic review registered in PROSPERO (REDACTED).

METHODS

This review used the PECOD framework to identify quantitative questions. We systematically searched seven electronic databases (Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, PubMed, Embase, PsycArticles, and PsycInfo) for articles published between 1 January 1992 and 13 July 2022. Studies were critically appraised, and the results of this systematic review yielded a narrative summary of the findings.

RESULTS

Four randomized control trials and one quasi-experimental study published in English were included in the review. Narrative analysis indicated that patients undergoing CABG who were assigned to the group receiving music therapy reported significantly reduced anxiety levels compared with controls who did not listen to music. In addition, music therapy can effectively be used as a non-pharmacological intervention to manage anxiety pre- and post-operatively in CABG surgery. No members of the public or patients were involved in the design or conduct of the study.

Pain-related fear among adult patients undergoing open-heart surgery: an interpretative phenomenological analysis

BACKGROUND

One of the sources of anxiety and fear among patients undergoing open-heart surgery is the possibility of experiencing pain, such as sternotomy-related chest pain. Giving them the chance to express their feelings about the potential pain may be effective in reducing their anxiety and may support their coping strategies.

OBJECTIVES

To examine pain-related fear among patients undergoing open-heart surgery and to understand the underlying reasons of their fears.

METHODS

A qualitative interview based on Heidegger's interpretative phenomenological approach was conducted adhering to the COREQ guidelines. Sixteen patients who were undergoing open-heart surgery in the following day were interviewed at the cardiovascular surgery ward of a university hospital. The organization and mapping of the qualitative data was done by using ATLAS.ti 8.0.

RESULTS

The patients who were afraid of experiencing pain after surgery seemed to be more concerned about open-heart surgery itself (such as pain from sternotomy and chest tubes) and the possibility of prolongation of postoperative pain. To cope with these fears, the patients employed a variety of social and self-coping strategies. Trusting the healthcare team, having a high pain tolerance, and having personal thoughts that take precedence over pain-related fear were the key factors explaining not being afraid of experiencing pain.

CONCLUSIONS

This study provides a deeper understanding of the underlying reasons and the needs of patients in controlling their pain-related fears before open-heart surgery. Trusting the healthcare professionals is one of the main factors for patients to control their pain-related fears. To develop a supportive sense of trust and to help patients in controlling their pain-related fears, surgical nurses must dedicate enough time for understanding patients' concerns while planning their nursing care plans. Future studies may focus on exploring the role of nursing interventions and multidisciplinary team approaches on the management of preoperative pain-related fear.

Describing and Predicting Preprocedural Anxiety in Patients Scheduled for Advanced Gastrointestinal Endoscopy During the COVID-19 Pandemic

Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently, with little attention given to a patient's preprocedural anxiety issues. Compounding this concern, in 2020 the COVID-19 pandemic resulted in the delay of many endoscopy cases. It is unknown how this affected the anxiety of patients preparing for advanced endoscopy procedures. Patients with higher anxiety require higher doses of anesthetic medications, and experience increased pain and decreased satisfaction. The purpose of this study was to describe the biological, psychological, and social attributes of patients and identify whether social support, COVID-19-related anxiety, delay of procedure, patient's physical status, and procedural indication category were predictors of state anxiety levels in patients undergoing advanced gastrointestinal endoscopy during the COVID-19 pandemic. The research study was a cross-sectional descriptive design with 90 patients. Patients were classified into low state and high state anxiety groups. Fifty-eight percent of patients had high state anxiety scores. Using logistic regression, social support was identified as a predictor of preprocedural anxiety (odds ratio [OR] = 0.318 [95% confidence interval, CI = 0.170, 0.597, p < .001]) as less social support was associated with higher anxiety. It is imperative that strategies to maximize social support are reinforced.

Effect of an educational video about ERAS on reducing preoperative anxiety and promoting recovery

Video propaganda is reported effectively improving patients' understanding of operation. However, whether a video introducing patients' most concerns can reduce preoperative anxiety and promote recovery stays unsealed. In this study, we investigated the effects of complementary therapy of educational video during preoperative visit. The results showed that thirty-five (23.2%) parents in Group Control were diagnosed as anxiety according to SAS, and nineteen (12.3%) patients were diagnosed after video intervention. The APAIs anxiety score and APAIs information score in Group Video were lower than those in Group Control. Compared with Group Control, video visit helped to increase the first-attempt pass rate of the knowledge retention exam and solve the patient's most worried concerns, and decrease incidence of emergence agitation, total cost of hospitalization and length of hospital stay. Moreover, video visit improved satisfaction degrees of patients and their main family members. Briefly, our study demonstrated video visit can improve patients' knowledge of anesthesia and decrease their preoperative anxiety, which may represent an important complementary therapy to routine preoperative visits.

Three-dimensional printing in modelling mitral valve interventions

Mitral interventions remain technically challenging owing to the anatomical complexity and heterogeneity of mitral pathologies. As such, multi-disciplinary pre-procedural planning assisted by advanced cardiac imaging is pivotal to successful outcomes. Modern imaging techniques offer accurate 3D renderings of cardiac anatomy; however, users are required to derive a spatial understanding of complex mitral pathologies from a 2D projection thus generating an 'imaging gap' which limits procedural planning. Physical mitral modelling using 3D printing has the potential to bridge this gap and is increasingly being employed in conjunction with other transformative technologies to assess feasibility of intervention, direct prosthesis choice and avoid complications. Such platforms have also shown value in training and patient education. Despite important limitations, the pace of innovation and synergistic integration with other technologies is likely to ensure that 3D printing assumes a central role in the journey towards delivering personalised care for patients undergoing mitral valve interventions.

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

BACKGROUND

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

CLINICALTRIALS

gov Identifier: NCT05487430.

The epidemiology of new persistent hypnotic/sedative use after surgical procedures: a retrospective cohort study

The use of hypnotic and sedative medication for sleep improvement is common and long-term use has been associated with an increased risk of adverse events and mortality. A proportion of patients might develop long-term use after initiating new persistent use following surgery. This retrospective cohort study aimed to determine the incidence of new persistent hypnotic/sedative use after surgical procedures and associated patient and procedural factors. Data on prescriptions for hypnotic and sedative medications used for sleep improvement were retrieved from the National Prescription Medicine Registry. Medication naivety was defined as not filling a prescription for hypnotics/sedatives from 365 days through 31 days preceding surgery, new use was defined as medication naivety followed by filling a prescription for hypnotic/sedative medication from 30 days before surgery through 14 days after surgery. New persistent hypnotic/sedative use was defined as new use followed by filling another hypnotic/sedative prescription from 15 days through 365 days after surgery. Of 55,414 patients included in the study, 43,297 were naive to hypnotic/sedative medications. Of those naive patients, 4.6% met the criteria for new peri-operative use, of whom 51.6% developed new persistent hypnotic/sedative use. Patient and procedural factors associated with increased risk of new persistent use were older age; female sex; the presence of malignant neoplasm; ischaemic heart disease; and having undergone either cardiac or thoracic surgery. The hazard of long-term mortality was higher for patients with new persistent use (1.39, 95%CI 1.22-1.59) compared with patients who remained naive. While a small ratio of surgical patients initiates the use of hypnotics/sedatives in the peri-operative period, a substantial proportion of these develop persistent use, which is associated with adverse outcomes. Over time, the proportion of patients using hypnotics/sedatives has declined, but the risk of persistent use within this group has remained stable.

Virtually Augmented Self-Hypnosis in Peripheral Vascular Intervention: A Randomized Controlled Trial

PURPOSE

Hypnosis is useful for diminishing distress during medical procedures. This study investigated the efficacy of virtually augmented self-hypnosis as an adjunctive non-pharmacological method for procedural pain and anxiety relief during endovascular interventions (EVI).

METHODS

We compared an immersive distraction experience (clinicaltrials.gov identifier NCT04561596) featuring virtual reality (VR) using a head-mounted display versus treatment as usual (TAU). Patients followed the "Aqua" module (Oncomfort™) consisting of a scuba dive and breathing exercises. They experienced a self-induced dissociative state similar to clinical hypnosis without direct intervention of a professional. Enrollment followed a 1:1 randomized open study (VR or TAU). Patients' feelings were evaluated just before and after the procedure, and 3 months following intervention. Anxiety was evaluated using the State Trait Anxiety Inventory (STAI) and pain (sensory, emotional, and memory) with a visual analogue scale (VAS).

RESULTS

This study included 100 patients. Mean anxiety (pre-post) was significantly reduced within groups and between groups (difference of 4.2 points, p = 0.016). The percentage of responders to anxiety lowering were 76 and 46% for VR and TAU, respectively (p = 0.004). The two groups did not significantly differ in mean sensory-intensity and affective emotional pain (pre-post) using VAS, in negative memories concerning remembered pain at 3 months (difference > 1 from immediate post-procedural reported pain intensity), mean procedural time, or the need for analgesic or sedative drugs.

CONCLUSIONS

VR self-hypnosis has the potential to improve the management of patients' distress during radiological procedures. It is safe and effective for reducing anxiety during EVI.

Turkish Validity and Reliability Study of the Surgical Anxiety Questionnaire for Adult Patients

PURPOSE

This research aims to adapt the Surgical Anxiety Questionnaire (SAQ) to Turkish culture and conduct validity and reliability studies.

DESIGN

This research is a methodological study.

METHODS

The sample of the research consisted of 311 patients and research data were collected between April 2019 and May 2021.

FINDINGS

The scale content validity index was 0.931. As a result of the factor analysis, the items were distributed in four subdimensions and explained 58.745% of the variance, and the model had good fit values. The Cronbach's α coefficient of the scale was 0.890.

CONCLUSIONS

The Turkish version of SAQ is a valid and reliable measurement tool and can be used for adult patients.

Assessment of preoperative anxiety and depression in patients with pulmonary ground-glass opacities: Risk factors and postoperative outcomes

Objective

A large number of patients with pulmonary ground-glass opacities (GGOs) have anxiety and depression. However, the contributing factors and effects of anxiety and depression on postoperative outcomes are still unclear.

Methods

Clinical data for patients undergoing surgical resection for pulmonary GGOs were collected. We prospectively evaluated levels and risk factors for anxiety and depression in patients with GGOs before surgery. The relationship between psychological disorders and postoperative morbidity was evaluated. Quality of life (QoL) was also assessed.

Results

A total of 133 patients were enrolled. Prevalence rates of preoperative anxiety and depression were 26.3% (n = 35) and 18% (n = 24), respectively. Multivariate analysis revealed depression [odds ratio(OR) = 16.27, p < 0.001] and multiple GGOs (OR = 3.146, p = 0.033) to be risk factors for preoperative anxiety. Anxiety (OR = 52.166, p < 0.001), age > 60 (OR = 3.601, p = 0.036), and unemployment (OR = 8.248, p = 0.006) were identified as risk factors for preoperative depression. Preoperative anxiety and depression were associated with lower QoL and higher postoperative pain scores. Our results also revealed that the incidence of postoperative atrial fibrillation was higher in patients with than in those without anxiety.

Conclusions

In patients with pulmonary GGOs, comprehensive psychological assessment and appropriate management are required before surgery to improve QoL and reduce postoperative morbidity.

New perspectives in patient education for cardiac surgery using 3D-printing and virtual reality

Background

Preoperative anxiety in cardiac surgery can lead to prolonged hospital stays and negative postoperative outcomes. An improved patient education using 3D models may reduce preoperative anxiety and risks associated with it.

Methods

Patient education was performed with standardized paper-based methods (n = 34), 3D-printed models (n = 34) or virtual reality models (n = 31). Anxiety and procedural understanding were evaluated using questionnaires prior to and after the patient education. Additionally, time spent for the education and overall quality were evaluated among further basic characteristics (age, gender, medical expertise, previous non-cardiac surgery and previously informed patients). Included surgeries were coronary artery bypass graft, surgical aortic valve replacement and thoracic aortic aneurysm surgery.

Results

A significant reduction in anxiety measured by Visual Analog Scale was achieved after patient education with virtual reality models (5.00 to 4.32, Δ-0.68, p < 0.001). Procedural knowledge significantly increased for every group after the patient education while the visualization and satisfaction were best rated for patient education with virtual reality. Patients rated the quality of the patient education using both visualization methods individually [3D and virtual reality (VR) models] higher compared to the control group of conventional paper-sheets (control paper-sheets: 86.32 ± 11.89%, 3D: 94.12 ± 9.25%, p < 0.0095, VR: 92.90 ± 11.01%, p < 0.0412).

Conclusion

Routine patient education with additional 3D models can significantly improve the patients' satisfaction and reduce subjective preoperative anxiety effectively.

How could perioperative anxiety be addressed via surgical team communication approaches? Findings from a scoping review

OBJECTIVES

Surgical patients and their families experience high rates of perioperative anxiety, which determine a negative impact on their surgery-related outcomes. Understanding what communicational aspects positively impact perioperative anxiety may help promote more efficient, patient-centered communication approaches which could address this issue. The aim of this scoping review was to synthesize published research on communication between surgical employees and adult patients and their relatives, and its role in managing perioperative anxiety.

METHODS

A scoping review approach was used across four international databases to search for publications detailing communicational interventions and approaches employed in surgical contexts and their impact on surgical patients' and their caregivers' perioperative anxiety levels. Results were narratively synthesized.

RESULTS

Twenty-two studies were included in this scoping review, which were grouped according to their communication intervention into one of five categories: technology-assisted interventions, interpersonal communication, educational programs, tools for facilitating exchange of information and theory-derived communication strategies. Records reported mixed results in terms of reducing perioperative anxiety. Facilitating and hindering factors in interpersonal communication in this context were further synthesized.

CONCLUSION

A multitude of communicational approaches and their effect on anxiety have been investigated within surgical settings, with varying results. Existing evidence suggests that it is vital to address surgical patients' anxiety through personalized empathetic communication, tailored to an individual's case, preferences, and needs. Key aspects of patient-healthcare professional communication which may impact perioperative anxiety were identified and may be utilized in future trainings for communication skills among surgical teams.

Diagnostic Concordance between the Visual Analogue Anxiety Scale (VAS-A) and the State-Trait Anxiety Inventory (STAI) in Nursing Students during the COVID-19 Pandemic

Anxiety is one of the most common problems among nursing students. The State-Trait Anxiety Inventory (STAI) is used to detect anxiety in this population; however, its length hinders speedy detection. For this reason, a faster and more efficient instrument is needed for early detection. This study aimed to determine the relationship between the anxiety measurement scales State-Trait Anxiety Inventory (STAI) and the Visual Analogue Scale for Anxiety (VAS-A) by establishing a discrimination threshold through the contrast of true positive rates (VPR) and false positive rates (FPR). To this end, a cross-sectional quantitative observational and analytical study was carried out on 185 fourth-year nursing students. The data collected were anxiety (STAI and VAS-A) and socio-demographic variables during the COVID-19 pandemic. The results showed a correlation between the two scales (VAS-A and STAI). The VAS-A is a useful instrument for assessing students in a crisis that could potentially generate anxiety. The study established a reasonably safe error probability range (>5%), allowing the VAS-A scale to be used as a rapid diagnostic or pre-diagnostic tool, depending on the scores. The study shows that speedy detection of anxiety using the VAS-A and an in-depth approach with the STAI by teaching staff in crises is possible.

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

BACKGROUND

Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery.

METHODS

Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross-sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia- and surgery-related. Statistical analysis included multivariate linear logistic regression and point-biserial correlation.

RESULTS

Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39-86 years), 62.3% had previous surgery. High-level anesthesia- and surgery-related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high-level anesthesia-related anxiety were having no children (OR = 0.443, 95% CI: 0.239-0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043-5.045, p = 0.039), and time since diagnosis for ≥ 4 months (OR = 1.634, 95% CI: 1.023-5.983, p = 0.04). The female sex independently predicted high-level surgery-related preoperative anxiety (OR = 2.387, 95% CI: 1.432-3.979, p = 0.001). High-level anesthesia-related anxiety correlated with postoperative mental disorders (r_pb = 0.193, p = 0.001) and pulmonary complications (r_pb = 0.104, p = 0.042). Postoperative nausea (r_pb = 0.111, p = 0.03) and postoperative mental disorders (r_pb = 0.160, p = 0.002) correlated with high-level surgery-related preoperative anxiety.

CONCLUSIONS

Since preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.

Virtually Augmented Self-Hypnosis applied to endovascular interventions (VA-HYPO): Randomized Controlled Trial Protocol

Endovascular interventions (EVI) are increasingly performed as minimally-invasive alternatives to surgery and have many advantages, including a decreased need for general anesthesia. However, EVI can be stressful for patients and often lead to anxiety and pain related to the procedure. The use of local anesthetics, anxiolytics, and analgesic drugs can help avoid general anesthesia. Nevertheless, these drugs have potential side effects. Alternative nonpharmacological therapies can improve patients’ experience during conscious interventions and reduce the need for additional medications. The added value of virtually augmented self-hypnosis (VA-HYPO) and its potential to reduce pain and anxiety during peripheral and visceral arterial and venous EVI is unknown. This is a prospective two-arm trial designed to randomize 100 patients in two groups according to the use or not of VA-HYPO during peripheral EVI as a complementary nonpharmacological technique to improve patient comfort. The main objective is to compare per-procedural anxiety, and the secondary aim is to compare the rated per-procedural pain in both groups. The potential significance is that VA-HYPO may improve patients’ experience during peripheral and visceral arterial and venous EVI and other minimally invasive interventions performed under local anesthesia.

Trial registration: Our study is registered on clinicaltrials.gov, with trial registration number: NCT04561596.

Relationship Between Preoperative Anxiety and Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

BACKGROUND

Atrial fibrillation is a form of arrhythmia that frequently occurs after coronary artery bypass graft surgery. Psychological factors may be involved in the development of atrial fibrillation, although the specific effect of anxiety remains unclear.

PURPOSE

This study was designed to evaluate the relationship between preoperative anxiety levels and atrial fibrillation after coronary artery bypass graft surgery.

METHODS

This descriptive design study recruited a sample of 126 patients. The data were collected by the researcher using a patient information form and the State-Trait Anxiety Scale.

RESULTS

Atrial fibrillation developed in 26.5% of the sample. Those who developed atrial fibrillation had a mean trait anxiety scale score of 40.2 ± 7.8, which is statistically significant. According to the results of logistic regression, it was observed that increased trait anxiety score, increased age, presence of comorbid disease, and noncompliance with respiratory physiotherapy increased the risk of developing atrial fibrillation.

CONCLUSION/IMPLICATIONS FOR PRACTICE

Preoperative anxiety levels were shown to be a significant factor promoting the development of atrial fibrillation after coronary artery bypass graft surgery. The results support measuring anxiety levels in patients as a standard procedure before performing this surgical procedure.

The effectiveness of preoperative education interventions on improving perioperative outcomes of adult patients undergoing cardiac surgery: a systematic review and meta-analysis

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.

A multicenter survey of perioperative anxiety in China: Pre- and postoperative associations

OBJECTIVES

To describe patient characteristics associated with preoperative anxiety and subsequently assess the relationship between preoperative anxiety and postoperative anxiety, pain, sleep quality, nausea and vomiting.

METHODS

The study collected data from patients undergoing elective operation from 12 hospitals in China. The State-Trait Anxiety Inventory (STAI) and the Athens Insomnia Scale (AIS) were used to assess anxiety and sleep quality before surgery. Evaluations of anxiety, pain, sleep quality, nausea and vomiting were quantified using the Visual Analogue Scale on postoperative days 1 and 2.

RESULTS

Data from 997 patients were analyzed. Preoperatively, 258 (25.9%) patients had high anxiety (STAI-State>44). Multivariate analyses showed a significant relationship between high anxiety and female gender (OR: 1.66, 95% CI: 1.08-2.57, p = 0.02), highly invasive surgery (OR: 2.29, 95% CI: 1.29-4.06, p = 0.005), higher trait anxiety (OR: 1.24, 95% CI: 1.20-1.28, p < 0.001) and insomnia (AIS ≥ 6, OR: 1.79, 95% CI: 1.17-2.76, p = 0.008). Preoperative anxiety demonstrated a negative correlation with postoperative anxiety following highly invasive surgery; this became a positive relationship following less invasive surgery. Preoperative anxiety was also positively related to postoperative pain and poor sleep quality. The correlation between preoperative anxiety and postoperative nausea and vomiting was not statistically significant.

CONCLUSION

Female gender, highly invasive surgery, higher trait anxiety and insomnia are independent risk factors for high preoperative anxiety. Surgical invasiveness influences association between pre- and postoperative anxiety. Higher preoperative anxiety is related to poorer sleep quality and more severe pain postoperatively.

Preoperative concerns of patients undergoing general surgery

OBJECTIVES

This qualitative review aims to provide a clearer understanding of concerns general surgery (GS) patients face in the preoperative period.

METHODS

Medline, CINAHL, PsycINFO and Web of Science were searched for articles describing the preoperative concerns of GS patients. Qualitative and mixed method studies were included. Key quotes were extracted, coded, and thematically analyzed according to Thomas and Harden's methodology.

RESULTS

27 articles were included. Three main themes were generated: (1) lead-up to surgery, (2) postoperative recovery process and (3) standard of care. While waiting for surgery, patients were often shrouded with uncertainty and concerned themselves with the potential impacts of their disease and surgery on their wellbeing and recovery. Furthermore, patients' trust and confidence in Healthcare Professionals (HCPs) was compromised when standard of care was perceived to be deficient, resulting in doubts about HCPs' credibility and capabilities.

CONCLUSION

Patients' preoperative concerns often stem from the uncertainty and unfamiliarity surrounding surgery. To address this, a combination of effective preoperative education, individualised communication and involvement of social support should be considered.

PRACTICE IMPLICATIONS

Preoperative concerns can negatively impact patients and effective interventions will result in a better perioperative experience with fewer negative consequences arising from patients' fear and anxiety.

Health anxiety among adults with congenital heart disease

PURPOSE OF REVIEW

Adults with congenital heart disease (CHD) may experience anxiety specifically related to their medical condition. This review introduces the concepts of health anxiety and heart-focused anxiety, summarizes what is currently known about heart-focused anxiety among adults with CHD and offers suggestions to help adult CHD providers address heart-focused anxiety in their patients.

RECENT FINDINGS

Although minimal research has been conducted specific to this outcome, health anxiety may occur at any point across the lifespan of individuals with CHD. A recent study found that children and adolescents with CHD reported greater health anxiety than community peers. Health anxiety was commonly reported among adults with CHD presenting for psychological assessment. It was linked with older age, trait anxiety, perceived parental overprotection and greater CHD complexity in one study.

SUMMARY

Adults with CHD face many potential health-related stressors, including cardiac symptoms, treatments and interventions throughout the lifespan (including surgeries and other invasive procedures), the impact of CHD on daily lives and longer-term health expectations. Providers should be aware that heart-focused anxiety among patients is understandable and perhaps common. Patient-centred education and psychological intervention should be integrated within a comprehensive approach to long-term disease management.

Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

Impact of Music Therapy on Preoperative Anxiety and Degree of Cooperation With Anesthesia Induction in Children With Simple Congenital Heart Disease

PURPOSE

To evaluate the impact of music therapy (MT) on preoperative anxiety and degree of cooperation with anesthesia induction in children with simple congenital heart disease (CHD).

DESIGN

A randomized controlled clinical study.

METHODS

Ninety children were randomly assigned to the MT and control groups. The MT groups underwent a preoperative 30-minute session of MT, whereas the control group did not listen to any music and had the same amount of quiet time. The modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) was used to evaluate the patients' preoperative anxiety on entering the anesthesia waiting area (T1), 10 minutes after entering the waiting area (T2), and during the initiation of anesthesia induction (T3); the degree of cooperation with anesthesia induction was assessed using the Induction Compliance Checklist. The mean arterial blood pressure (MAP) and heart rate (HR) at T1, T2, T3, and T4 (the time of successful anesthesia) were also recorded.

FINDINGS

One child was excluded from the MT group, and one was excluded from the control group. No difference was found in the mYPAS-SF score, MAP, or HR between the two groups at T1. The mYPAS-SF scores of the MT group were significantly lower than those of the control group at T2 and T3. At T2, T3, and T4, the MAP and HR of the MT group were lower than those of the control group. A statistically significant difference was found in the Induction Compliance Checklist score between the two groups.

CONCLUSIONS

MT can reduce preoperative anxiety and improve the degree of cooperation with anesthesia induction.

The Impact of Nonpharmacological Interventions on Patient Experience, Opioid Use, and Health Care Utilization in Adult Cardiac Surgery Patients: Protocol for a Mixed Methods Study

BACKGROUND

Despite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting.

OBJECTIVE

This trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention.

METHODS

To address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor's office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis.

RESULTS

This trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020.

CONCLUSIONS

Data generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study's findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/21350.

Surgery cancellation: A scoping review of patients' experiences

AIMS AND OBJECTIVES

To review the literature on patients' experiences of surgery cancellation to gain knowledge of nursing care needs and identify gaps in evidence.

BACKGROUND

Surgery cancellations are an ongoing challenge in healthcare systems with negative impacts on healthcare costs, hospital staff and patients. Most research addresses the reasons for cancellation and implementation of preventive interventions, but limited knowledge exists about patients' experiences of cancellation.

DESIGN

The scoping review was undertaken using the methodology recommended by the Joanna Briggs Institute for Scoping Reviews and the Reporting Cheklist for Scoping Reviews (PRISMA-ScR).

METHODS

A systematic search was conducted by two independent researchers in Cochrane Library, CINAHL, PubMed and PsycINFO. A forward and backward citation search was performed in Scopus, and references in relevant studies were explored. The tool Covidence was applied to select, compare and discuss relevant articles. The Mixed Methods Appraisal Tool was used for critical appraisal.

RESULTS

Surgery cancellation is emotionally harmful with negative effects on patients. Four themes were identified: 'Initial reactions to cancellation', 'Reactions during a new waiting period at home and during readmission to hospital', 'Information about cancellation' and 'The experience of new practical arrangements'. Patients whose surgery was cancelled experienced initial feelings such as anger, rejection and anxiety and physical/psychosomatic symptoms in the extended waiting period. Patients prefered early sufficient information about cancellation from the surgeon. The practical arrangements were stressfull for the patients.

CONCLUSION

Nursing care and identification of vulnerable patients are essential to prevent negative effects in the extended waiting period. Provision of timely, sufficient and professional information about cancellation from the surgeon is important. Further research assessing consequences of cancellation is needed.

RELEVANCE TO CLINICAL PRACTICE

Patients would benefit if hospitals find systems to minimise cancellation, and healthcare professionals could systematically develop professional supportive interventions tailored to patients' individual needs.

Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis

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.

Sense of coherence, mental well-being and perceived preoperative hospital and surgery related stress in surgical patients with malignant, benign, and no neoplasms

BACKGROUND

This prospective, cross-sectional, observational study examined associations between sense of coherence (SOC), mental well-being, and perceived preoperative hospital and surgery related stress of surgical patients with malignant, benign, and no neoplasms. The objective was to assess a putative association between SOC and preoperative stress, and to test for a statistical mediation by mental well-being.

METHOD

The sample consisted of 4918 patients from diverse surgical fields, of which 945 had malignant neoplasms, 333 benign neoplasms, and 3640 no neoplasms. For each subsample, we conducted simple mediation analyses to test an indirect effect of SOC on preoperative stress mediated by mental well-being. The models were adjusted for age, gender, and essential medical factors.

RESULTS

Patient groups did not differ significantly regarding degrees of SOC and mental well-being (SOC, M [SD]: 12.31 [2.59], 12.02 [2.62], 12.18 [2.57]; mental well-being M [SD]: 59.26 [24.05], 56.89 [22.67], 57.31 [22.87], in patients with malignant, benign, and without neoplasms, respectively). Patients without neoplasms reported significantly lower stress (4.19 [2.86], M [SD]) than those with benign (5.02 [3.03], M [SD]) and malignant neoplasms (4.99 [2.93], M [SD]). In all three mediation models, SOC had significant direct effects on stress, with higher SOC being associated with lower stress (- 0.3170 [0.0407], - 0.3484 [0.0752], - 0.2919 [0.0206]; c' [SE], p < 0.001 in patients with malignant, benign, and without neoplasms, respectively). In patients with malignant neoplasms and without neoplasms, SOC showed small indirect effects on stress that were statistically mediated by well-being. Higher SOC was related to higher well-being, which in turn was related to lower stress. In patients with benign neoplasms, however, no significant indirect effects of SOC were found.

CONCLUSIONS

SOC was directly associated with lower perceived hospital and surgery related stress, over and above the direct and mediation effects of mental well-being. Because the data are cross-sectional, conclusions implying causality cannot be drawn. Nevertheless, they indicate important relationships that can inform treatment approaches to reduce elevated preoperative stress by specifically addressing low SOC.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01357694 . Registered 18 May 2011.

Elective cardiac surgery during the COVID-19 pandemic: Proceed or postpone?

During this coronavirus disease 2019 (COVID-19) pandemic, there is an international call to postpone all elective surgeries. Cardiac surgery carries a combined risk for cardiac patients, who are at risk for higher complications of COVID-19, and healthcare workers. In response to the COVID-19 pandemic, the American College of Surgeons and the American Society of Anesthesiologists recommended a sustained reduction in the rate of new COVID-19 cases for 14 days before the resumption of the elective surgery, but postponing surgery may impact patients' daily activities and increase the risk the of deterioration of their cardiac condition. We will discuss the risks and benefits of the decision whether to postpone or proceed with elective cardiac surgical procedures during the escalating COVID-19 pandemic considering the specific risk of the cardiac patients, the unique characteristics of the surgery, and the international health system capacity.

Can hypnosis and virtual reality reduce anxiety, pain and fatigue among patients who undergo cardiac surgery: a randomised controlled trial

Background

Different non-pharmacological techniques, including hypnosis and virtual reality (VR) are currently used as complementary tools in the treatment of anxiety, acute and chronic pain. A new technique called virtual reality hypnosis (VRH), which encompasses a combination of both tools, is regularly used although its benefits and underlying mechanisms remain unknown to date. With the goal to improve our understanding of VRH combination effects, it is necessary to conduct randomised and controlled research trials in order to understand their clinical interest and potential benefits.

Methods

Patients (n = 100) undergoing cardiac surgery at the Liège University Hospital will be randomly assigned to one of four conditions (control, hypnosis, VR or VRH). Each patient will receive two sessions of one of the techniques: one the day before the surgery and one the day after. Physiological assessments will be made on the monitor and patients will rate their levels of anxiety, fatigue, pain, absorption and dissociation.

Discussion

This study will help to expand knowledge on the application of virtual reality, hypnosis and VRH in the specific context of cardiac and intensive care procedures, and the influence of these non-pharmacological techniques on patient’s anxiety, fatigue, pain and phenomenological experience.

Trial registration

ClinicalTrials.gov: NCT03820700. Date registered on 29 January 2019.

Study recruitment date: October 6, 2018. Study anticipated completion date: December 28, 2020.

Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study

Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients' desire to obtain information related to their heart surgery.This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15-0.65, P < .001) and past anesthesia exposure (OR 2.38, 95% CI 1.01-5.62, P < .05) were identified as risk factors for developing anxiety before cardiac surgery. Further, female gender (IRR 0.80, 95% CI 0.67-0.94, P < .001), higher education levels (IRR 1.18, 95% CI 1.01-1.40, P < .05), and higher preoperative anxiety (IRR 1.44, 95% CI 1.21-1.73, P < .001) could lead to higher levels of desire to acquire information related to the procedure.The study concluded that more than a half of the cardiac surgery patients experiences preoperative anxiety; female gender and having past anesthesia exposure are the risk factors. Anxious patients have more desire to acquire knowledge about the procedure. Thus, the evaluation and adequate management of preoperative anxiety should be proposed in high-risk groups.

Correlation between Preoperative Anxiety and ABO Blood Types: Evidence from a Clinical Cross-Sectional Study

Gene-environment interaction is identified as the determinant in anxiety. ABO blood types represent a part of the genetic phenotype. Therefore, we assume ABO blood types correlate with preoperative anxiety. This cross-sectional study enrolled 352 patients with different ABO blood types, scheduled for elective surgery between 2018 and 2019 in the First Affiliated Hospital of Shihezi University. HADS (hospital anxiety and depression scale) scores and VA (visual analogue scales for anxiety) scores were all used to assess the preoperative anxiety in the A, B, AB, and O groups. Bivariate correlation and logistic regression were performed to identify relationships between preoperative anxiety and related variables. A significant difference in VA and HADS-A (anxiety) scores was found between the AB and other groups. The ratio of preoperative anxiety was 3.73 (95% CI [confidence interval]: 2.32-6.00, P < 0.001) times in female than in male; 0.36 (95% CI: 0.21-0.63, P < 0.001) times in ASA (American Society of Anesthesiologists) grade II than in grade I; 0.41 (95% CI: 0.20-0.86, P < 0.05) times in ASA grade III than in grade I; 1.25 (95% CI: 1.1-1.41, P < 0.001) times in higher VAS (visual analogue scales for pain) scores than in lower VAS scores; and 0.28 (95% CI: 0.16-0.49, P < 0.01) times in non-AB blood type than in AB blood type. Differences in ABO blood types were found in preoperative anxiety, and the AB group displayed a high preoperative anxiety level. ABO blood types, sex, ASA grade, and VAS were associated with preoperative anxiety. This trial is registered with ChiCTR1800019390.

Psychiatric disturbances in patients undergoing open-heart surgery

Background

Emotional and behavioral problems have been noted in a considerable number of patients after open-heart surgery. However, great discrepancy exists in the literature regarding the frequency and the course of psychiatric symptoms, cognitive performance, and quality of life among those patients. This prospective study was designed to assess the pre- and postoperative psychiatric profile, as well as the quality of life of patients undergoing open-heart surgery.

Methods

One hundred patients who were prepared for cardiac surgery and met our selection criteria were recruited in this study. Each patient was subjected to the Hospital Anxiety and Depression Scale, the Mini-Mental State Examination with selective subtests of Wechsler Adult intelligence scale, and the Short Form 36 questionnaire to assess psychiatric symptoms, cognitive performance, and quality of life respectively. Assessment was done for each of the evaluated items before surgery as well as at 1 week and 6 months postoperatively.

Results

The anxiety and depressive symptoms were significantly lower at 6 months postoperatively than preoperatively. The cognitive performance declined after 1 week, then improved significantly at the 6-month follow-up. The quality of life scale was significantly lower preoperatively than after surgery.

Conclusions

Anxiety and depressive symptoms, which occurred in substantial percentage of patients undergoing open-heart surgery, were gradually improved with time. Cognitive functions showed early deterioration with significant improvement at 6 months. Psychiatric problems had an adverse impact on patients’ quality of life which raised the importance of psychiatric consultation before and after cardiac surgeries to shorten recovery time.

Preoperatory Anxiety in Patients Undergoing Cardiac Surgery

Anxiety is a feeling of discomfort produced in face of an unknown event, as an impending cardiac surgery, that can lead to inconveniences in the intervention and subsequent recovery. Being the purpose of this research to analyze pre-surgical anxiety, a descriptive cross-sectional study among patients undergoing cardiac surgery was carried out. Data about sociodemographic variables were collected and the level of anxiety prior to surgery was assessed using the STAI-S scale. Subsequently, descriptive data analyses were performed, relationships among variables were analyzed, and a binary logistic regression model was developed in order to analyze the role of the variables involved in the development of preoperative anxiety. Sixty subjects were finally included; more than 80% had a moderate to high level of anxiety. 26.7% underwent valve surgery and 47% underwent coronary artery bypass graft (CABG) surgery, in the latter case presenting higher levels of anxiety. Statistically significant relationships were found among the level of anxiety and (a) level of studies, (b) first surgical intervention, and (c) the rating given to their previous surgical experience. We concluded that preoperative anxiety in people undergoing cardiac surgery is high and yet it is an underestimated phenomenon. The relationship between the received information and their anxiety level is inversely proportional, so that people programmed for cardiac surgery should be provided with all the information they required, through an individualized intervention.

Incidence and features of preoperative anxiety in patients undergoing elective non-cardiac surgery

The study was conducted at the Centre of Anaesthesiology, Intensive Care and Pain Management of Vilnius University Hospital Santaros Klinikos.

Background

Due to its implications on postoperative outcomes and patient satisfaction, anxiety evaluation should be incorporated in the preoperative assessment of the patients.

Materials and methods

A series of consecutive patients undergoing elective surgery were included in the study. Preoperative anxiety was evaluated using the Hospital Anxiety and Depression Scale (HADS), the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and the Visual Analogue (Face) Scale (VAFS). Qualitative and quantitative analyses were used to describe features of anxiety.

Results

149 patients were included in the study, of whom 40.9% were scheduled for low, 47.7% for intermediate, and 11.4% for high-risk procedures. Based on HADS, 19 patients (12.6%) were positive for anxiety. VAFS revealed that 10.3% of patients experience medium/high intensity of anxiety. Patients were mostly concerned about the success (29.3%) and complications (11.4%) of the surgery APAIS score analysis revealed significantly higher anxiety (p < 0.01) and a need of information (p < 0.01) about surgery compared to anaesthesia. In contrast to age, education, or previous surgery, anxiety was associated with female sex (p < 0.01), surgical risk (p = 0.02), and subjective health evaluation (p < 0.01).Patients tended to choose a conversation with the doctor (45.6%) or a relative (44.8%) as a measure to relieve anxiety, and 18.4% would choose medication. Praying, music therapy, massage, or even sexual intercourse were among the measures suggested by patients.

Conclusions

A significant part of patients experience anxiety before surgery, predominantly about the success of the surgery. According to the patients, conversation is the best option to reduce anxiety.

Ansiedade e desfechos clínicos em pacientes coronariopatas submetidos ao cateterismo não programado

Resumo Objetivos Descrever o nível de ansiedade traço e estado em pacientes com síndrome coronariana aguda submetidos a cateterismo não programado; verificar a influência da ansiedade traço na ansiedade estado antes e após o cateterismo e verificar se a ansiedade (traço e estado) é preditiva da ocorrência de arritmias não fatais, da gravidade dos pacientes medida pela classificação Killip e pelo índice de comorbidade de Charlson, e do tempo de permanência hospitalar. Métodos Estudo observacional, correlacional e longitudinal, no qual foram avaliados participantes com síndrome coronariana aguda aguardando cateterismo cardíaco não programado. No encontro inicial (Ti) foram coletados dados sociodemográficos e clínicos, aplicados inventários de ansiedade traço e estado (IDATE) e de depressão de Beck. No encontro final (Tf), aplicou-se o IDATE-estado. Os participantes foram acompanhados até alta hospitalar ou óbito quanto a ocorrência de arritmias não fatais e tempo de permanência hospitalar. Resultados Foram incluídos 100 participantes (62,2±11,4 anos; 61% do sexo masculino). O escore do IDATE-traço foi 42,2±10,4 e influenciou o escore do IDATE-estado em Ti e Tf (p<0,005). O IDATE-estado diminuiu significativamente de Ti para Tf (40,2±10,4 vs 37,2±11,2, respectivamente, p=0,002). Não se observou associação do IDATE-traço ou do IDATE-estado com os índices de gravidade, tempo de permanência hospitalar ou ocorrência de arritmias. Entretanto, o escore de depressão aumentou 9,5% a chance de ocorrência de arritmias (OR=1,009; IC95%=0,913-1,115). Conclusão O nível de ansiedade reduziu de forma significativa após a realização do cateterismo, e não foi um preditor de desfechos clínicos em curto prazo.