Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Kapucijnenvoer 35/4, B-3000, Leuven, Belgium.
Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.
BMC Geriatr. 2023 Mar 30;23(1):198. doi: 10.1186/s12877-023-03923-0.
Postoperative delirium (POD) is a common postoperative complication associated with multiple adverse consequences on patient outcomes and higher medical expenses. Preoperative anxiety has been suggested as a possible precipitating factor for the development of POD. As such, we aimed to explore the association between preoperative anxiety and POD in older surgical patients.
Electronic databases including MEDLINE (via PubMed), EMBASE (via Embase.com), Web of Science Core Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL Complete; via EBSCOhost) and clinical trial registries were systematically searched to identify prospective studies examining preoperative anxiety as a risk factor for POD in older surgical patients. We used Joanna Briggs Institute Critical Appraisal Checklist for Cohort Studies to assess the quality of included studies. The association between preoperative anxiety and POD was summarized with odds ratios (ORs) and 95% confidence intervals (CIs) using DerSimonian-Laird random-effects meta-analysis.
Eleven studies were included (1691 participants; mean age ranging between 63.1-82.3 years). Five studies used a theoretical definition for preoperative anxiety, with the Anxiety subscale of Hospital Anxiety and Depression Scale (HADS-A) as the instrument being most often used. When using dichotomized measures and within the HADS-A subgroup analysis, preoperative anxiety was significantly associated with POD (OR = 2.17, 95%CI: 1.01-4.68, I = 54%, Tau = 0.4, n = 5; OR = 3.23, 95%CI: 1.70-6.13, I = 0, Tau = 0, n = 4; respectively). No association was observed when using continuous measurements (OR = 0.99, 95%CI: 0.93-1.05, I = 0, Tau = 0, n = 4), nor in the subgroup analysis of STAI-6 (six-item version of state scale of Spielberger State-Trait Anxiety Inventory, OR = 1.07, 95%CI: 0.93-1.24, I = 0, Tau = 0, n = 2). We found the overall quality of included studies to be moderate to good.
An unclear association between preoperative anxiety and POD in older surgical patients was found in our study. Given the ambiguity in conceptualization and measurement instruments used for preoperative anxiety, more research is warranted in which a greater emphasis should be placed on how preoperative anxiety is operationalized and measured.
术后谵妄（POD）是一种常见的术后并发症，与患者结局和更高的医疗费用的多个不良后果相关。术前焦虑被认为是 POD 发展的一个可能的诱发因素。因此，我们旨在探讨老年手术患者术前焦虑与 POD 之间的关系。
系统检索 MEDLINE（通过 PubMed）、EMBASE（通过 Embase.com）、Web of Science 核心合集、护理学和联合健康文献累积索引（CINAHL Complete；通过 EBSCOhost）和临床试验注册处的电子数据库，以确定前瞻性研究，检查术前焦虑作为老年手术患者 POD 的危险因素。我们使用 Joanna Briggs 研究所队列研究的批判性评价清单来评估纳入研究的质量。使用 DerSimonian-Laird 随机效应荟萃分析，总结术前焦虑与 POD 之间的关联，使用比值比（OR）和 95%置信区间（CI）。
纳入了 11 项研究（1691 名参与者；平均年龄在 63.1-82.3 岁之间）。五项研究使用了术前焦虑的理论定义，其中最常使用的工具是医院焦虑和抑郁量表（HADS-A）的焦虑子量表。当使用二分测量值并进行 HADS-A 亚组分析时，术前焦虑与 POD 显著相关（OR=2.17，95%CI：1.01-4.68，I=54%，Tau=0.4，n=5；OR=3.23，95%CI：1.70-6.13，I=0，Tau=0，n=4）。当使用连续测量值时（OR=0.99，95%CI：0.93-1.05，I=0，Tau=0，n=4），或在 STAI-6（状态焦虑量表的 6 项版本，Spielberger 状态特质焦虑量表）亚组分析中（OR=1.07，95%CI：0.93-1.24，I=0，Tau=0，n=2），没有观察到相关性。我们发现纳入研究的整体质量为中等至良好。
在本研究中，我们发现老年手术患者术前焦虑与 POD 之间的关系不明确。鉴于术前焦虑的概念化和测量工具的模糊性，需要进行更多的研究，在这些研究中，应该更加重视如何操作和测量术前焦虑。
