Kassahun Woubet Tefera, Mehdorn Matthias, Wagner Tristan Cedric, Babel Jonas, Danker Helge, Gockel Ines
Faculty of Medicine, Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstr. 20, 04103, Leipzig, Germany.
Department of Medical Psychology and Sociology, University of Leipzig, Leipzig, Germany.
Sci Rep. 2022 Apr 15;12(1):6312. doi: 10.1038/s41598-022-10302-z.
Excessive levels of anxiety may negatively influence treatment outcomes and likely increase patient suffering. We designed a prospective observational study to assess whether preoperative patient-reported anxiety affects major general surgery outcomes. We prospectively administered the State-Trait Anxiety Inventory (STAI) to measure preoperative anxiety in patients awaiting major general surgical procedures. Patients were grouped by STAI scores according to established cutoffs: no anxiety (STAI < 40) and anxiety (STAI ≥ 40). Four hundred patients completed the questionnaires and underwent surgery, with an average interval from questionnaire completion to surgery of 4 days. Applying a state anxiety (STAI-S) score ≥ 40 as a reference point, the prevalence of patient-reported anxiety was 60.5% (241 of 400). The mean STAI-S score for these patients was 50.48 ± 7.77. The mean age of the entire cohort was 58.5 ± 14.12 years. The majority of participants were male (53.8%). The distribution of sex by anxiety status showed that 53.5% of women and 46.5% of men had anxiety (p = 0.003). In the entire cohort, postoperative complications occurred in 23.9% and 28.6% of the no anxiety and anxiety groups, respectively. The difference was nonsignificant. In a subgroup of patients who underwent high-risk complex procedures (N = 221), however, postoperative complications occurred in 31.4% and 45.2% of the no anxiety and anxiety groups, respectively. This difference was significant at p = 0.004. Of the patients who were anxious, 3.3% (8 of 241) died during hospitalization following surgery, compared with 4.4% of the patients (7 of 159) who were not anxious (p = 0.577). In the multivariable analysis adjusted for covariates and based on the results of subgroup analysis, preoperative anxiety assessed by the STAIS score was associated with morbidity (OR 2.12, CI 1.14-3.96; p = 0.018) but not mortality. The majority of enrolled patients in this study were classified as having high- to very high-level preoperative clinical anxiety, and we found a significant quantitative effect of patient-reported anxiety on morbidity but not mortality after surgery.
过度焦虑可能会对治疗结果产生负面影响，并可能增加患者的痛苦。我们设计了一项前瞻性观察性研究，以评估术前患者报告的焦虑是否会影响普通外科大手术的结果。我们前瞻性地应用状态-特质焦虑量表（STAI）来测量等待普通外科大手术患者的术前焦虑。根据既定的临界值，将患者按STAI评分分组：无焦虑（STAI＜40）和焦虑（STAI≥40）。400名患者完成了问卷调查并接受了手术，从问卷完成到手术的平均间隔时间为4天。以状态焦虑（STAI-S）评分≥40作为参考点，患者报告焦虑的患病率为60.5%（400例中的241例）。这些患者的平均STAI-S评分为50.48±7.77。整个队列的平均年龄为58.5±14.12岁。大多数参与者为男性（53.8%）。按焦虑状态划分的性别分布显示，53.5%的女性和46.5%的男性有焦虑（p = 0.003）。在整个队列中，无焦虑组和焦虑组术后并发症的发生率分别为23.9%和28.6%。差异无统计学意义。然而，在接受高风险复杂手术的患者亚组（N = 221）中，无焦虑组和焦虑组术后并发症的发生率分别为31.4%和45.2%。这一差异在p = 0.004时具有统计学意义。焦虑患者中，3.3%（241例中的8例）在术后住院期间死亡，而非焦虑患者的这一比例为4.4%（159例中的7例）（p = 0.577）。在对协变量进行调整并基于亚组分析结果的多变量分析中，通过STAIS评分评估的术前焦虑与发病率相关（OR 2.12，CI 1.14 - 3.96；p = 0.018），但与死亡率无关。本研究中纳入的大多数患者被归类为术前临床焦虑程度为高至非常高，并且我们发现患者报告的焦虑对术后发病率有显著的定量影响，但对死亡率没有影响。
