Prevalence of Pre-Operative Anxiety and Predictors among Elective Surgical Patients and Their Pre-Operative Hemodynamic Changes at Muhimbili National Hospital
Background: Surgery is a traumatic process that may subject patients to physiological and psychological responses leading to pre and post-operative effects. Preoperative anxiety, if severe may be associated with several complications including cancellation of surgery, poor intra- and post-operative analgesic control, altered post-operative healing, and longer hospital stays to mention a few. Objective: The main purpose was to determine the prevalence and predictors of pre-operative anxiety among elective surgical patients and their hemodynamic changes in these patients in the Surgical department in MNH. Methodology: This was a prospective descriptive and analytical study performed at MNH which involved patients admitted for elective surgical procedures from June 2021 to February 2022. Information was gathered in a structured questionnaire along with APAIS scores. Results: 169 patients for elective surgery in General Surgery and Urology units were included in the study. Among them, 94 males and 74 females. The overall pre-operative anxiety was 11.8%, 80.5% had moderate to severe Information-Related anxiety, while 26% and 17.2% had moderate-to-severe surgery-related and anesthesia-related types of anxiety respectively. Conclusion: Pre-operative anxiety was comparatively lower in our settings as well no factor was found with a significant relation to pre-operative anxiety, hence further and broader evaluation is recommended to result in the assessment and management of patients before elective surgery.
References
[1]
al’Absi, M. and Arnett, D.K. (2000) Adrenocortical Responses to Psychological Stress and Risk for Hypertension. Biomedicine & Pharmacotherapy, 54, 234-244. https://doi.org/10.1016/S0753-3322(00)80065-7
[2]
Maier, W., Buller, R., Philipp, M. and Heuser, I. (1988) The Hamilton Anxiety Scale: Reliability, Validity and Sensitivity to Change in Anxiety and Depressive Disorders. The Journal of Affective Disorders, 14, 61-68.
[3]
Hornblow, A.R. and Kidson, M.A. (1976) The Visual Analogue Scale for Anxiety: A Validation Study. Australian & New Zealand Journal of Psychiatry, 10, 339-341. https://doi.org/10.3109/00048677609159523
[4]
Vitasari, P., et al. (2011) Re-Test of State Trait Anxiety Inventory (STAI) among Engineering Students in Malaysia: Reliability and Validity Tests. Procedia—Social and Behavioral Sciences, 15, 3843-3848.
[5]
Zhong, Q.Y., Gelaye, B., Zaslavsky, A.M., et al. (2015) Diagnostic Validity of the Generalized Anxiety Disorder-7 (GAD-7) among Pregnant Women. PLOS ONE, 10, e0125096. https://doi.org/10.1371/journal.pone.0125096
[6]
Wu, H., Zhao, X., Chu, S., et al. (2020) Validation of the Chinese Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Health and Quality of Life Outcomes, 18, Article No. 66. https://doi.org/10.1186/s12955-020-01294-3
[7]
Blen, A., Ayele, B., Tadesse, M., et al. (2021) Translation of the Amsterdam Preoperative Anxiety and Information Score (APAIS) into the Amharic Version and Its Validation for Evaluation of Preoperative Anxiety. Ethiopian Journal of Health Sciences, 31, 349-358. https://doi.org/10.4314/ejhs.v31i2.18
[8]
Boker, A., Brownell, L. and Donen, N. (2002) The Amsterdam Preoperative Anxiety and Information Scale Provides a Simple and Reliable Measure of Preoperative Anxiety. Canadian Journal of Anesthesia, 49, 792-798. https://doi.org/10.1007/BF03017410
[9]
Aytekin, A., Doru, Ö. and Kucukoglu, S. (2016) The Effects of Distraction on Preoperative Anxiety Level in Children. Journal of PeriAnesthesia Nursing, 31, 56-62. https://doi.org/10.1016/j.jopan.2014.11.016
[10]
Broadbent, E., Kahokehr, A., Booth, R.J., et al. (2012) A Brief Relaxation Intervention Reduces Stress and Improves Surgical Wound Healing Response: A Randomised Trial. Brain, Behavior, and Immunity, 26, 212-217. https://doi.org/10.1016/j.bbi.2011.06.014
[11]
Sigdel, S. (n.d.) Perioperative Anxiety: A Short Review. https://doi.org/10.15761/GAPM.1000126
[12]
Buckley, U. and Shivkumar, K. (2016) Stress-Induced Cardiac Arrhythmias: The Heart-Brain Interaction. Trends in Cardiovascular Medicine, 26, 78-80.
[13]
Eberhart, L., Aust, H., Schuster, M., et al. (2020) Preoperative Anxiety in Adults—A Cross-Sectional Study on Specific Fears and Risk Factors. BMC Psychiatry, 20, Article No. 140. https://doi.org/10.1186/s12888-020-02552-w
[14]
Bedaso, A. and Ayalew, M. (2019) Preoperative Anxiety among Adult Patients Undergoing Elective Surgery: A Prospective Survey at a General Hospital in Ethiopia. Patient Safety in Surgery, 13, Article No. 18. https://doi.org/10.1186/s13037-019-0198-0
[15]
Nigussie, S., Belachew, T. and Wolancho, W. (2014) Predictors of Preoperative Anxiety among Surgical Patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia. BMC Surgery, 14, Article No. 67. https://doi.org/10.1186/1471-2482-14-67
[16]
Yilmaz, M., Sezer, H. and Gu, H. (2011) Predictors of Preoperative Anxiety in Surgical Inpatients. Journal of Clinical Nursing, 21, 956-964. https://doi.org/10.1111/j.1365-2702.2011.03799.x
[17]
Matthias, A.T. and Samarasekera, D.N. (2012) Preoperative Anxiety in Surgical Patients—Experience of a Single Unit. Acta Anaesthesiologica Taiwanica, 50, 3-6. https://doi.org/10.1016/j.aat.2012.02.004
[18]
Mulugeta, H., Ayana, M., Sintayehu, M., Dessie, G. and Zewdu, T. (2018) Preoperative Anxiety and Associated Factors among Adult Surgical Patients in Debre Markos and Felege Hiwot Referral Hospitals, Northwest Ethiopia. BMC Anesthesiology, 18, Article No. 155. https://doi.org/10.1186/s12871-018-0619-0
[19]
Woldegerima, Y.B., Fitwi, G.L., Yimer, H.T. and Hailekiros, A.G. (2018) Prevalence and Factors Associated with Preoperative Anxiety among Elective Surgical Patients at University of Gondar Hospital. Gondar, Northwest Ethiopia, 2017. A Cross-Sectional Study. International Journal of Surgery Open, 10, 21-29. https://doi.org/10.1016/j.ijso.2017.11.001
[20]
Kiyohara, L.Y., Kayano, L.K., Oliveira, L.M., et al. (2004) Surgery Information Reduces Anxiety in the Pre-Operative Period. Revista do Hospital das Clínicas, 59, 51-56. https://doi.org/10.1590/S0041-87812004000200001
[21]
Menel, M., Nawel, Z., Rania, F., et al. (2018) Preoperative Anxiety in the Tertiary Care Hospitals of Sousse, Tunisia: Prevalence and Predictors. SOJ Surgery, 5, 1-5.
[22]
Aasa, A., Hovba, M. and Bertero, C.M. (2013) The Importance of Preoperative Information for Patient Participation in Colorectal Surgery Care. Journal of Clinical Nursing, 22, 1604-1612. https://doi.org/10.1111/jocn.12110
[23]
Jlala, H.A., French, J.L., Foxall, G.L., et al. (2010) Effect of Preoperative Multimedia Information on Perioperative Anxiety in Patients Undergoing Procedures under Regional Anaesthesia. Regional Anaesthesia, 104, 369-374. https://doi.org/10.1093/bja/aeq002
[24]
Jayawardane, M., Gankanda, W. and Gunathilake, M. (2021) Prevalence of Pre-Operative Anxiety and Associated Factors among a Group of Women Undergoing Gynaecological Surgeries at a Single Unit in a Tertiary Care Hospital in Sri Lanka [Version 1; Peer Review: 1 Approved, 2 Approved with Reservations]. F1000Research, 10, 74. https://doi.org/10.12688/f1000research.26964.1
[25]
Kesimci, E. (2017) Factors Associated with Preoperative Anxiety Levels of Turkish Surgical Patients?: From a Single Center in Ankara. Patient Preference and Adherence, 11, 291-296. https://doi.org/10.2147/PPA.S127342
[26]
Zeb, A., Ali, M., Baig, R., Rahman, S. and Zeb, A. (2019) Pre-Operative Anxiety in Patients at Tertiary Care Hospital Peshawar Pakistan. South Asian Research Journal of Nursing and Healthcare, 1, 26-30. https://doi.org/10.36346/sarjnhc.2019.v01i01.004
[27]
Mekonnen, S., Ali, Y. and Basu, B. (2020) Global Prevalence and Determinants of Preoperative Anxiety among Surgical Patients: A Systematic Review and Meta-Analysis. International Journal of Surgery Open Global, 25, 6-16. https://doi.org/10.1016/j.ijso.2020.05.010
[28]
Ryamukuru, D., Ndateba, I., Mukamana, D. and Mukantwari, J. (2019) Assessment of Anxiety in Patients Awaiting Surgery in a Referral Hospital in Rwanda. Rwanda Journal of Medicine and Health Sciences, 2, 112-117. https://doi.org/10.4314/rjmhs.v2i2.6
[29]
Caumo, W. and Ferreira, M.B.C. (2003) Perioperative Anxiety: Psychobiology and Effects in Postoperative Recovery. The Pain Clinic, 15, 87-101.
[30]
Wells, J., Vargas, M., et al. (1986) Pre-Surgical Anxiety and Postsurgical Pain and Adjustment, Effect of Stress Inoculation Procedure. Journal of Consulting and Clinical Psychology, 6, 831-835. https://doi.org/10.1037/0022-006X.54.6.831
[31]
Cserép, Z., Losoncz, E., Balog, P., et al. (2012) The Impact of Preoperative Anxiety and Education Level on Long-Term Mortality after Cardiac Surgery. Journal of Cardiothoracic Surgery, 7, Article No. 86. https://doi.org/10.1186/1749-8090-7-86
[32]
Ali, B., Hamid, P., Amirreza, S. and Morteza, H. (2021) Pre-Operative Anxiety among Iranian Adult Patients Undergoing Elective Surgeries in Educational Hospitals. Journal of Education and Health Promotion, 10, 815-820.
[33]
Corman, H.H., Hornick, E.J., Kritchman, M. and Terestman, N. (1958) Emotional Reactions of Surgical Patients to Hospitalization, Anesthesia and Surgery. The American Journal of Surgery, 96, 646-653. https://doi.org/10.1016/0002-9610(58)90466-5
[34]
Tanaka, N., Ohno, Y. and Hori, M. (2015) Predicting Preoperative Hemodynamic Changes Using the Visual Analog Scale. Journal of PeriAnesthesia Nursing, 30, 460-467. https://doi.org/10.1016/j.jopan.2014.02.005
[35]
Ahmetovic-Djug, J., Hasukic, S., Djug, H. and Hasukic, B. (2017) Impact of Preoperative Anxiety in Patients on Hemodynamic Changes and a Dose of Anesthetic during Induction of Anesthesia. Medical Archives, 71, 330-333. https://doi.org/10.5455/medarh.2017.71.330-333