Preoperative anxiety and its associated factors among women undergoing elective caesarean delivery: a cross-sectional study

Prevalence of Preoperative Anxiety and Associated Factors Among Surgical Patients: Systematic Review and Meta-Analysis in Ethiopia

Background

Preoperative anxiety is commonly characterized as a feeling of tension, apprehension, nervousness, distressing fear, and emotional discomfort preceding surgery. Different studies across the countries indicated an inconsistent prevalence of preoperative anxiety and its associated factors. Therefore, this study aimed to determine the pooled prevalence of preoperative anxiety and associated factors among surgical patients in Ethiopia.

Methods

In this study, all observational study designs conducted in Ethiopia were included while studies that did not report our main outcome of interest or did not meet the quality criteria by Joanna Briggs Institute (JBI) critical appraisal techniques were excluded. Electronic databases (PubMed, SCOPUS, Web of Science Core Collection, CAB Abstract, EMBASE, and CINHAL (EBSCO)), Google Scholar, and lists of references were used to search works of literature in Ethiopia. STATA version 17 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Computing values assessed heterogeneity among the studies for I 2 and P-values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias respectively.

Results

A total of 10 studies were included with a total of 3054 participants. The pooled prevalence of preoperative anxiety among surgical patients in Ethiopia was 60% (95% CI: 55-66, P < .001, I 2 = 90.00%). The overall prevalence among non-obstetric patients was 59% (95% CI: 53-66) while among obstetric 66% (95% CI: 62-69). Fear of complication (AOR = 2.32, 95% CI: 1.23, 3.41, P = .62, I 2 = 0.00%), postoperative pain (AOR = 1.92, 95% CI: 1.29, 2.56, P = .37, I 2 = 0.00%), and fear of death (AOR = 2.27, 95% CI: 1.53, 3.00, P = .70, I 2 = 0.00%) were significantly associated with preoperative anxiety.

Conclusion

This study revealed a high pooled prevalence of preoperative anxiety among surgical patients in Ethiopia. The findings showed that fear of complication, postoperative pain, and fear of death were significantly associated with preoperative anxiety. This implies that a multidisciplinary approach involving various healthcare professionals is essential to optimize patient care and outcomes by addressing postoperative pain through pain management, counselling on fear of death, and complications to reduce the level of preoperative anxiety.

Pharmacologic Analgesia for Cesarean Section: An Update in 2024

PURPOSE OF THE REVIEW

With the increasing prevalence of cesarean section globally, the importance of perioperative analgesia for cesarean section is becoming increasingly evident. This article provides an overview and update on the current status of cesarean section worldwide and associated analgesic regimens.

RECENT FINDINGS

Some recent studies unveiled potential association of neuraxial analgesia might be associated with children's autism, pharmacologic analgesia in obstetric will potentially gain some more attention. Various commonly used techniques and medications for analgesia in cesarean section are highlighted. While neuraxial administration of opioid remains the most classic method, the use of multimodal analgesia, particularly integration of nonsteroidal anti-inflammatory drugs, acetaminophen, peripheral nerve blocks has provided additional and better options for patients who are not suitable for intrathecal and neuraxial techniques and those experiencing severe pain postoperatively. Optimal pain management is crucial for achieving better clinical outcomes and optimal recovery, and with the continuous development of medications, more and better pharmacologic regimen will be available in the future.

Effect of Birth Story on Personality Traits and Death Anxiety

OBJECTIVES

The aim of this study is to determine the effect of the birth story of individuals on personality traits and death anxiety.

METHODS

This descriptive and analytical research was completed with 1,635 people who participated voluntarily. The study data were collected with the Personal Information Form, Cervantes Personality Scale (CPS), and Abdel-Khalek Death Anxiety Scale (ASDA).

RESULTS

The research sample is average means 31.63 ± 11.04 years, most of the female (72.7%) and married (54.6%). In our study, it was observed that women's death anxiety was higher than men's. Our study found that individuals born by caesarean section had greater neurotic personality traits, emotional stability/neuroticism score averages, and death anxiety scores compared to individuals born vaginally.

CONCLUSION

In the model made with multiple regression analysis, birth type did not significantly predict death anxiety, while sex and emotional stability/neuroticism personality trait significantly predicted death anxiety.

Effectiveness of preoperative multimedia educational sessions on the levels of anxiety and satisfaction among women undergoing cesarean: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to explore the effectiveness of preoperative multimedia educational sessions on the levels of anxiety and satisfaction among women undergoing cesarean section (CS). The Scopus, PubMed, and Cochrane databases were searched without language limitations for eligible randomized controlled trials (RCTs) published from their inception up to October 15, 2023. A random-effect meta-analysis was conducted, and the quality of this meta-analysis was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Seven RCTs (n = 1006 women) met the inclusion criteria. Preoperative multimedia sessions were found to significantly reduce anxiety levels (n = 6 RCTs, weighted mean difference: -3.10; 95 percent confidence intervals (CI): -4.48, -1.73; I2 = 44.24 percent, moderate certainty of evidence) compared to the control group. However, there was no significant difference between the two groups regarding women's satisfaction after surgery (n = 5 RCTs, risk ratio: 1.37; 95 percent CI: 0.76, 2.50; I2 = 98.26 percent, moderate certainty of evidence). Leave-one-out sensitivity analysis showed robustness of the outcomes. The findings of this meta-analysis suggest that providing multimedia educational programs before surgery could potentially have a beneficial effect on the levels of anxiety experienced by women undergoing CS. However, it is imperative to validate these results through larger samples and multi-centered RCTs.

Informational video on preoperative anxiety and postoperative satisfaction prior to elective cesarean delivery: a systematic review and meta-analysis

BACKGROUND

Preoperative anxiety affects 60 to 80% of patients who are candidates for surgery. Reducing preoperative anxiety can improve surgical outcomes, shorten hospital stays, and minimize disruptions in lifestyle. Having information affects people ability to identify important points and improve their understanding, and lack of information causes fear and anxiety, which negatively affects decision-making. Studies have shown that the intervention of education before cesarean section has a beneficial effect on women anxiety level. Providing information before surgery can reduce patients' anxiety. This study was conducted to determine the effect of information video before elective cesarean delivery on preoperative anxiety and post-operative satisfaction.

METHODS

The search for relevant studies was systematically conducted in PubMed, Scopus, Web of Science, Cochrane Library, SID (Persian database), and Google Scholar (search engine) until July 4, 2023, in both English and Persian languages. The revised tool for assessing the risk of bias in randomized trials (RoB 2.0) and ROBIN-I were used to evaluate the risk of bias, and heterogeneity was assessed using I². In cases of high heterogeneity, a random effects model was used instead of a fixed effects model. Subgroup analysis was performed based on the duration of the video, and the type of intervention for the primary outcome. Sensitivity analysis was conducted based on the type of study. A random-effects meta-regression analysis was conducted to identify potential sources of high heterogeneity for preoperative anxiety. The certainty of the evidence was assessed using GRADE.

RESULTS

A total number of 557 articles were found in databases. Three hundred sixty-eight studies were screened based on their titles, abstracts, and full texts. Of these, 16 studies were assessed for eligibility, and 7 were excluded. Ultimately, nine papers were included. Meta-analysis results showed that the information video before elective cesarean delivery compared to control group may have little or no effect on preoperative anxiety, but the evidence is uncertain (SMD - 0.22, 95% CI -0.51 to 0.06, 9 trials, 1020 participants, I2 = 80%; very low-certainty evidence). Also, it probably increases the post-operative satisfaction (SMD 0.26, 95% CI 0.10 to 0.42, 5 trials, 618 participants, I2 = 0%; Moderate-certainty evidence). The random effect meta-regression analyses indicated a significant correlation between the mean age of the intervention group (β = 0.137, P < 0.001) and the mean age of the control group (β = 0.150, P = 0.0246) with effect size.

CONCLUSION

This study found that watching an informational video prior to elective cesarean delivery resulted in a decrease in preoperative anxiety. However, it is important to note that the reduction was not statistically significant, and there was a high level of inconsistency among the results. Nonetheless, the intervention did lead to an improvement in women's post-operative satisfaction. To determine the optimal time duration and content type of informational videos, further studies with more appropriate methodology are necessary.

Preoperative Anxiety Impact on Anesthetic and Analgesic Use

Anxiety is a complex emotional state that can arise from the anticipation of a threatening event, and preoperative anxiety is a common experience among adult patients undergoing surgery. In adult patients, the incidence of preoperative anxiety varies widely across different surgical groups, and it can result in a variety of psychophysiological responses and problems. Despite its negative impact, preoperative anxiety often receives insufficient attention in clinical practice. To improve pain management strategies, there is a need for further research on personalized approaches that take into account various factors that contribute to an individual's pain experience. These personalized approaches could involve developing tools to identify individuals who are more likely to experience increased pain and may require additional analgesia. To address this, regular assessments of anxiety levels should be conducted during preoperative visits, and counseling should be provided to patients with high levels of anxiety. Identifying and addressing preoperative anxiety in a timely manner can help reduce its incidence and potential consequences.

Prevalence of preoperative anxiety among hospitalized patients in a developing country: a study of associated factors

BACKGROUND

Preoperative anxiety is a health concern among patients scheduled for surgical interventions. Little is known about the prevalence of preoperative anxiety among patients in different healthcare systems of developing countries. This study was conducted to determine the prevalence of preoperative anxiety among patients undergoing surgery in Palestine. Another objective was to identify the factors associated with preoperative anxiety.

METHODS

This study was conducted in a cross-sectional descriptive design. Patients scheduled for surgical interventions were interviewed using an interviewer-administered questionnaire. The questionnaire collected the demographic, clinical, and surgical variables of the patients. The questionnaire also contained the Amsterdam preoperative anxiety and information scale (APAIS), and a short version of the Spielberger state-trait anxiety inventory (STAIS-5/STAIT-5).

RESULT

A total of 280 patients were included. The mean APAIS total score was 13.6 ± 5.9, the mean APAIS anxiety domain score was 8.3 ± 4.3, and the mean APAIS need for information domain was 1.6 ± 0.50. Of the patients, 76 (27.1%) had high anxiety and 160 (57.1%) expressed a high need for information. The higher APAIS anxiety scores were predicted by being female, having chronic diseases, being scheduled to be operated on within 24 h, and having experienced surgical complications. The mean STAIS-5 score was 10.0 ± 4.2 and the mean STAIT-5 was 10.3 ± 3.8. Of the patients, 140 (50.0%) had high state anxiety and 56 (20.0%) had high trait anxiety. Higher STAIS-5 scores were predicted by being female, younger than 42 years, and scheduled to be operated on within 24 h. Higher STAIT-5 scores were predicted by being female. A positive correlation was identified between APAIS total, APAIS anxiety, APAIS need for information, STAIS-5, and STAIT-5 scores.

CONCLUSION

Preoperative anxiety was prevalent among patients scheduled for surgical operations in Palestinian hospitals. Anesthesiologists and other providers of perioperative care should screen preoperative patients who are female, have chronic diseases, are scheduled to be operated on within 24 h, and having had experienced surgical complications for preoperative anxiety. More studies are still needed to investigate the effects of the implemented measures on the prevalence of preoperative anxiety.