Preoperative Anxiety among Adult Patients Undergoing Elective Surgeries at a Tertiary Teaching Hospital: A Cross-Sectional Study during the Era of COVID-19 Vaccination
Abstract
:1. Introduction
2. Materials and Methods
2.1. Design
2.2. Inclusion and Exclusion Criteria
2.3. Ethical Approval
2.4. Questionnaire
2.5. Statistical Analysis
3. Results
4. Discussion
4.1. Prevalence of Preoperative Anxiety
4.2. Factors Related to Preoperative Anxiety
4.3. The Reason for Preoperative Anxiety
4.4. Preoperative Anxiety and COVID-19
4.5. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Weiser, T.G.; Regenbogen, S.E.; Thompson, K.D.; Haynes, A.B.; Lipsitz, S.R.; Berry, W.R.; Gawande, A.A. An estimation of the global volume of surgery: A modelling strategy based on available data. Lancet 2008, 372, 139. [Google Scholar] [CrossRef]
- Bedaso, A.; Ayalew, M. Preoperative anxiety among adult patients undergoing elective surgery: A prospective survey at a general hospital in Ethiopia. Patient Saf. Surg. 2019, 13, 18. [Google Scholar] [CrossRef] [PubMed]
- Aust, H.; Eberhart, L.; Sturm, T.; Schuster, M.; Nestoriuc, Y.; Brehm, F.; Rüsch, D. A cross-sectional study on preoperative anxiety in adults. J. Psychosom. Res. 2018, 111, 133–139. [Google Scholar] [CrossRef] [PubMed]
- Sigdel, D.S. Perioperative anxiety: A short review. Glob. Anesth. Perioper. Med. 2015, 1, 107–108. [Google Scholar] [CrossRef]
- Abate, S.M.; Chekol, Y.A.; Basu, B. Global prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and meta-analysis. Int. J. Surg. Open 2020, 25, 6–16. [Google Scholar] [CrossRef]
- Farbood, A.; Sahmeddini, M.A.; Bayat, S.; Karami, N. The effect of preoperative depression and anxiety on heart rate variability in women with breast cancer. Breast Cancer 2020, 27, 912–918. [Google Scholar] [CrossRef]
- Bayrak, A.; Sagiroglu, G.; Copuroglu, E. Effects of Preoperative Anxiety on Intraoperative Hemodynamics and Postoperative Pain. J. Coll. Phys. Surg. Pak. 2019, 29, 868–873. [Google Scholar] [CrossRef]
- Andersson, V.; Bergstrand, J.; Engström, Å.; Gustafsson, S. The Impact of Preoperative Patient Anxiety on Postoperative Anxiety and Quality of Recovery After Orthopaedic Surgery. J. Perianesthesia Nurs. 2020, 35, 260–264. [Google Scholar] [CrossRef]
- Yang, K.; Wen, G.; Yang, J.; Zhou, S.; Da, W.; Meng, Y.; Xue, Y.; Tao, L. Complication and Sequelae of COVID-19: What Should We Pay Attention to in the Post-Epidemic Era. Front. Immunol. 2021, 12, 711741. [Google Scholar] [CrossRef]
- Luo, M.; Guo, L.; Yu, M.; Jiang, W.; Wang, H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public—A systematic review and meta-analysis. Psychiatry Res. 2020, 291, 113190. [Google Scholar] [CrossRef]
- Aloweidi, A.; Bsisu, I.; Suleiman, A.; Abu-Halaweh, S.; Almustafa, M.; Aqel, M.; Amro, A.; Radwan, N.; Assaf, D.; Abdullah, M.Z.; et al. Hesitancy towards covid-19 vaccines: An analytical cross–sectional study. Int. J. Environ. Res. Public Health 2021, 18, 5111. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Side Effects of COVID-19 Vaccines. Available online: https://www.who.int/news-room/feature-stories/detail/side-effects-of-covid-19-vaccines (accessed on 15 January 2022).
- Eberhart, L.; Aust, H.; Schuster, M.; Sturm, T.; Gehling, M.; Euteneuer, F.; Rüsch, D. Preoperative anxiety in adults—A cross-sectional study on specific fears and risk factors. BMC Psychiatry 2020, 20, 140. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Mulugeta, H.; Ayana, M.; Sintayehu, M.; Dessie, G.; Zewdu, T. Preoperative anxiety and associated factors among adult surgical patients in Debre Markos and Felege Hiwot referral hospitals, Northwest Ethiopia. BMC Anesthesiol. 2018, 18, 155. [Google Scholar] [CrossRef] [PubMed]
- Doglietto, F.; Vezzoli, M.; Biroli, A.; Saraceno, G.; Zanin, L.; Pertichetti, M.; Calza, S.; Agosti, E.; Arias, J.M.A.; Assietti, R.; et al. Anxiety in neurosurgical patients undergoing nonurgent surgery during the COVID-19 pandemic. Neurosurg. Focus 2020, 49, 1–10. [Google Scholar] [CrossRef]
- Berth, H.; Petrowski, K.; Balck, F. The Amsterdam Preoperative Anxiety and Information Scale (APAIS)—The first trial of a German version. Psychosoc. Med. 2007, 4, Doc01. [Google Scholar]
- Ali, A.; Altun, D.; Oguz, B.H.; Ilhan, M.; Demircan, F.; Koltka, K. The effect of preoperative anxiety on postoperative analgesia and anesthesia recovery in patients undergoing laparascopic cholecystectomy. J. Anesth. 2014, 28, 222–227. [Google Scholar] [CrossRef]
- Acharya, S.; Gurung, R.; Parajuli, B. Preoperative Anxiety Assessment in Adult Patients Undergoing Elective Surgeries: A Cross-Sectional Observational Study. J. Inst. Med. Nepal 2020, 42, 18–22. [Google Scholar] [CrossRef]
- Matthias, A.T.; Samarasekera, D.N. Preoperative anxiety in surgical patients—Experience of a single unit. Acta Anaesthesiol. Taiwanica 2012, 50, 3–6. [Google Scholar] [CrossRef]
- Kindler, C.H.; Harms, C.; Amsler, F.; Ihde-Scholl, T.; Scheidegger, D. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg. 2000, 90, 706–712. [Google Scholar] [CrossRef] [Green Version]
- Erkilic, E.; Kesimci, E.; Soykut, C.; Doger, C.; Gumus, T.; Kanbak, O. Factors associated with preoperative anxiety levels of Turkish surgical patients: From a single center in Ankara. Patient Prefer. Adherence 2017, 11, 291–296. [Google Scholar] [CrossRef]
- Woldegerima, Y.B.; Fitwi, G.L.; Yimer, H.T.; Hailekiros, A.G. Prevalence and factors associated with preoperative anxiety among elective surgical patients at University of Gondar Hospital. Gondar, Northwest Ethiopia, 2017. A cross-sectional study. Int. J. Surg. Open 2018, 10, 21–29. [Google Scholar]
- Arthayasa, I.M.W.; Dewi, N.L.P.T.; Triyani, N.G.A.P.; Wati, K.L. Analysis of Factors Responsible for Preoperative Anxiety in Patients during the COVID-19 Pandemic at the Surgical Polyclinic of Sanglah General Hospital, Denpasar. Basic Appl. Nurs. Res. J. 2021, 1, 54–61. [Google Scholar] [CrossRef]
- Celik, F.; Edipoglu, I.S. Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur. J. Med. Res. 2018, 23, 41. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nigussie, S.; Belachew, T.; Wolancho, W. Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia. BMC Surg. 2014, 14, 67. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard with Vaccination Data: Jordan. Available online: https://covid19.who.int/region/emro/country/jo (accessed on 1 January 2022).
- Raed Omari. Jordan pushes child vaccinations to fight COVID-19 surge.Arab News. Available online: https://www.arabnews.com/node/1972466/middle-east (accessed on 15 January 2022).
- Balkhi, F.; Nasir, A.; Zehra, A.; Riaz, R. Psychological and Behavioral Response to the Coronavirus (COVID-19) Pandemic. Cureus 2020, 12, e7923. [Google Scholar] [CrossRef]
- Kahyaoglu Sut, H.; Kucukkaya, B. Anxiety, depression, and related factors in pregnant women during the COVID-19 pandemic in Turkey: A web-based cross-sectional study. Perspect Psychiatr. Care 2021, 57, 860–868. [Google Scholar] [CrossRef]
- Moghanibashi-Mansourieh, A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J. Psychiatr. 2020, 51, 102076. [Google Scholar] [CrossRef]
Characteristics | Anxiety Level * | Total (n = 794) | p Value | ||
---|---|---|---|---|---|
Low Anxiety (n = 555) | High Anxiety (n = 239) | ||||
Demographic data | |||||
Age (years) | 46.5 ± 16.1 | 41.2 ± 15.4 | 44.9 ± 16.1 | <0.001 | |
Gender | Male | 255 (45.9) | 60 (25.1) | 315 (39.7) | <0.001 |
Female | 300 (54.1) | 179 (74.9) | 479 (60.3) | ||
Marital status | Married | 440 (79.3) | 170 (71.1) | 610 (76.8) | 0.079 |
Single | 93 (16.8) | 55 (23.0) | 148 (18.6) | ||
Widow | 15 (2.7) | 8 (3.3) | 23 (2.9) | ||
Divorced | 7 (1.3) | 6 (2.5) | 13 (1.6) | ||
Educational level | Illiterate | 11 (2.0) | 1 (0.4) | 12 (1.5) | 0.134 |
Primary school | 41 (7.4) | 10 (4.2) | 51 (6.4) | ||
Secondary school | 174 (31.4) | 70 (29.3) | 244 (30.7) | ||
Middle school | 48 (8.6) | 21 (8.8) | 69 (8.7) | ||
Bachelors/college or higher | 281 (50.6) | 137 (57.3) | 418 (52.6) | ||
Employment status | Unemployed | 267 (48.1) | 117 (49.0) | 384 (48.4) | 0.827 |
Employed | 288 (51.9) | 122 (51.0) | 410 (51.6) | ||
Occupation field (n = 410) | Non-medical field | 262 (91.0) | 105 (86.1) | 367 (89.5) | 0.138 |
Medical field | 26 (9.0) | 17 (13.9) | 43 (10.5) | ||
Residency | Capital city | 331 (59.6) | 144 (60.3) | 475 (59.8) | 0.872 |
Governorates | 224 (40.4) | 95 (39.7) | 319 (40.2) | ||
Monthly income | Less than 500 JOD | 288 (51.9) | 125 (52.3) | 413 (52.0) | 0.903 |
500–1000 JOD | 215 (38,7) | 94 (39.3) | 309 (38.9) | ||
More than 1000 JOD | 52 (9.4) | 20 (8.4) | 72 (9.1) | ||
Anesthetic and surgical history | |||||
Type of upcoming surgery | Minor surgical procedure | 309 (55.7) | 123 (51.5) | 432 (54.4) | 0.274 |
Major surgical procedure | 246 (44.3) | 116 (48.5) | 362 (45.6) | ||
Type of upcoming anesthesia | General | 468 (84.3) | 208 (87.0) | 676 (85.1) | 0.326 |
Regional/neuraxial | 87 (15.7) | 31 (13.0) | 118 (14.9) | ||
Surgical discipline | Cardiac and vascular surgery | 21 (3.8) | 12 (5.0) | 33 (4.2) | 0.056 |
Endocrine surgery | 11 (2.0) | 6 (2.5) | 17 (2.1) | ||
Gastrointestinal surgery | 92 (16.6) | 45 (18.8) | 137 (17.3) | ||
Neurological surgery | 38 (6.8) | 15 (6.3) | 53 (6.7) | ||
Gynecological and obstetric surgeries | 108 (19.5) | 58 (24.3) | 166 (20.9) | ||
Oncological surgery | 5 (0.9) | 5 (2.1) | 10 (1.3) | ||
Orthopedics surgery | 79 (14.2) | 37 (15.5) | 116 (14.6) | ||
Otolaryngology surgery | 51 (9.2) | 25 (10.5) | 76 (9.6) | ||
Plastic surgery | 30 (5.4) | 10 (4.2) | 40 (5.0) | ||
Urological surgery | 120 (21.6) | 26 (10.9) | 146 (18.4) | ||
Previous history of surgery under anesthesia | 443 (79.8) | 169 (70.7) | 612 (77.1) | 0.005 | |
Number of previous surgeries (n = 612) | One | 153 (34.5) | 66 (39.1) | 219 (35.8) | 0.191 |
Two | 105 (23.7) | 46 (27.2) | 151 (24.7) | ||
Three or more | 185 (41.8) | 57 (33.7) | 242 (39.5) | ||
Previous history of surgical complications (n = 612) | 31 (7.0) | 17 (10.1) | 48 (7.8) | 0.208 | |
Previous history of anesthetic complications (n = 612) | 18 (4.1) | 13 (7.7) | 31 (5.1) | 0.067 | |
Family members or friends ever experienced any surgical complications | 28 (5.0) | 19 (7.9) | 47 (5.9) | 0.112 | |
Family members or friends ever experienced any anesthetic complications | 16 (2.9) | 12 (5.0) | 28 (3.5) | 0.134 | |
APAIS-A-T | 6.0 ± 2.2 | 14.3 ± 2.7 | 8.5 ± 4.5 | <0.001 | |
APAIS-A-An | 2.7 ± 1.2 | 6.6 ± 2.7 | 3.9 ± 2.5 | <0.001 | |
APAIS-A-Su | 3.3 ± 1.8 | 7.7 ± 2.2 | 4.6 ± 2.8 | <0.001 | |
APAIS-I | 4.5 ± 2.8 | 7.0 ± 2.8 | 5.3 ± 3.0 | <0.001 |
Surgical Characteristics | Number (Percent) | APAIS-A-T | APAIS-A-An | APAIS-A-Su | APAIS-I |
---|---|---|---|---|---|
Procedure type | |||||
Minor surgical procedure | 432 (54.4) | 8.3 ± 4.4 | 3.8 ± 2.5 | 4.5 ± 2.7 | 5.2 ± 3 |
Major surgical procedure | 362 (45.6) | 8.8 ± 4.6 | 4 ± 2.5 | 4.8 ± 2.9 | 5.4 ± 3 |
p value | 0.274 | 0.125 | 0.364 | 0.213 | 0.35 |
Surgical specialty | |||||
Cardiac and vascular surgery | 33 (4.2) | 9.2 ± 4.9 | 4.6 ± 2.9 | 4.6 ± 2.6 | 5.3 ± 3.2 |
Orthopedics surgery | 116 (14.6) | 8.7 ± 4.7 | 3.9 ± 2.6 | 4.8 ± 3.1 | 5.1 ± 3 |
Urological surgery | 146 (18.4) | 7.1 ± 3.9 | 3.4 ± 2.2 | 3.7 ± 2.4 | 4.9 ± 3.1 |
Plastic surgery | 40 (5.0) | 7.7 ± 4.3 | 3.2 ± 2.1 | 4.5 ± 3.2 | 5 ± 3.2 |
Gastrointestinal surgery | 137 (17.3) | 8.8 ± 4.3 | 4 ± 2.4 | 4.7 ± 2.6 | 5.6 ± 2.8 |
Otolaryngology surgery | 76 (9.6) | 8.4 ± 4.1 | 4.1 ± 2.6 | 4.3 ± 2.7 | 5.3 ± 2.9 |
Gynecological and obstetric surgeries | 166 (20.9) | 9.4 ± 4.7 | 4.1 ± 2.6 | 5.3 ± 2.9 | 5.5 ± 3.1 |
Neurosurgery | 53 (6.7) | 8.7 ± 5 | 3.7 ± 2.7 | 5 ± 3 | 4.5 ± 2.8 |
Endocrine surgery | 17 (2.1) | 8.8 ± 3.5 | 3.7 ± 1.7 | 5.1 ± 2.6 | 6.3 ± 3.2 |
Oncological surgery | 10 (1.3) | 11.5 ± 5.2 | 5.6 ± 3.6 | 5.9 ± 3.1 | 6.2 ± 3.3 |
p value | 0.056 | <0.001 | 0.02 | <0.001 | 0.139 |
Characteristics | Anxiety Level * | Total (n = 794) | p Value | |
---|---|---|---|---|
Low Anxiety (n = 555) | High Anxiety (n = 239) | |||
Factors making them anxious on surgery day | ||||
Fear of surgical complication | 123 (22.2) | 129 (54.0) | 252 (31.7) | <0.001 |
Fear of anesthesia | 82 (14.8) | 119 (49.8) | 201 (25.3) | <0.001 |
Fear of becoming infected with COVID-19 | 50 (9.0) | 47 (19.7) | 97 (12.2) | <0.001 |
Fear of doctors’ mistake | 115 (20.7) | 106 (44.4) | 221 (27.8) | <0.001 |
Fear of pain after surgery | 156 (28.1) | 118 (49.4) | 274 (34.5) | <0.001 |
Fear of death | 28 (5.0) | 64 (26.8) | 92 (11.6) | <0.001 |
None of the above | 241 (43.4) | 22 (9.2) | 263 (33.1) | <0.001 |
Factor that makes them the most anxious | ||||
Fear of anesthesia | 56 (10.1) | 81 (33.9) | 137 (17.3) | <0.001 |
Fear of surgical complication | 115 (20.7) | 103 (43.1) | 218 (27.5) | |
Fear of becoming infected with COVID-19 | 22 (4.0) | 7 (2.9) | 29 (3.7) | |
None of the above | 362 (65.2) | 48 (20.1) | 410 (51.6) |
Characteristics | Anxiety Level * | Total (n = 794) | p Value | ||
---|---|---|---|---|---|
Low Anxiety (n = 555) | High Anxiety (n = 239) | ||||
Previous history of COVID-19 | 154 (27.7) | 75 (31.4) | 229 (28.8) | 0.3 | |
Symptoms experienced (n = 229) | No symptoms | 17 (11.0) | 8 (10.7) | 25 (10.9) | 0.45 |
Mild (flu-like symptoms: fever, fatigue, myalgia, cough, runny nose) | 93 (60.4) | 39 (52.0) | 132 (57.6) | ||
Moderate (persistent fever, productive cough, wheezing) | 38 (24.7) | 26 (34.7) | 64 (27.9) | ||
Severe (hospitalization was needed for ICU and respiratory support) | 6 (3.9) | 2 (2.7) | 8 (3.5) | ||
Previous complication of COVID-19 (n = 229) | 17 (11.0) | 11 (14.7) | 28 (12.2) | 0.432 | |
Family members or friends experienced previous complication of COVID-19 | 133 (24.0) | 83 (34.7) | 216 (27.2) | 0.002 | |
Vaccinated against COVID-19 | 466 (84.0) | 187 (78.2) | 653 (82.2) | 0.053 | |
Fear of becoming infected with COVID-19 during their stay in the hospital | 103 (18.6) | 64 (26.8) | 167 (21.0) | 0.009 | |
Fear of becoming infected with COVID-19 made them hesitate having the surgery | 17 (3.1) | 19 (7.9) | 36 (4.5) | 0.002 | |
Having a vaccine against COVID-19 made them feel safer about having surgery | 236 (50.3) | 107 (56.0) | 343 (52.0) | 0.184 |
Variable | Univariable Regression | Univariable Regression | ||||||
---|---|---|---|---|---|---|---|---|
OR | 95% CI for OR | p Value | OR | 95% CI for OR | p Value | |||
Lower | Upper | Lower | Upper | |||||
Age | 0.98 | 0.97 | 0.99 | <0.001 | 0.98 | 0.97 | 0.99 | <0.001 |
Gender (Male) | 0.39 | 0.28 | 0.55 | <0.001 | 0.39 | 0.28 | 0.55 | <0.001 |
Educational level * | 0.169 | - | - | - | - | |||
Educational level (secondary school) | 4.43 | 0.56 | 34.92 | 0.158 | - | - | - | - |
Educational level (bachelor’s/college or higher) | 5.36 | 0.69 | 41.96 | 0.110 | - | - | - | - |
Educational level (middle school) | 4.81 | 0.58 | 39.71 | 0.144 | - | - | - | - |
Educational level (primary school) | 2.68 | 0.31 | 23.28 | 0.371 | - | - | - | - |
Previous history of surgery under anesthesia | 0.61 | 0.43 | 0.86 | 0.005 | 0.63 | 0.43 | 0.91 | 0.014 |
Previous history of surgical complications | 1.49 | 0.80 | 2.76 | 0.210 | - | - | - | - |
Previous history of anesthetic complications | 1.97 | 0.94 | 4.11 | 0.072 | - | - | - | - |
Previous history of COVID-19 | 1.19 | 0.86 | 1.66 | 0.300 | - | - | - | - |
Vaccinated against COVID-19 | 0.69 | 0.47 | 1.01 | 0.054 | - | - | - | - |
Fear of becoming infected with COVID-19 during their stay in the hospital | 1.60 | 1.12 | 2.29 | 0.009 | 1.47 | 1.02 | 2.14 | 0.041 |
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Aloweidi, A.; Abu-Halaweh, S.; Almustafa, M.; Marei, Z.; Yaghi, S.; Hababeh, L.; Al-Gallab, N.; Al-Jaberi, S.; Ghattas, L.; Alrabadi, S.R.; et al. Preoperative Anxiety among Adult Patients Undergoing Elective Surgeries at a Tertiary Teaching Hospital: A Cross-Sectional Study during the Era of COVID-19 Vaccination. Healthcare 2022, 10, 515. https://doi.org/10.3390/healthcare10030515
Aloweidi A, Abu-Halaweh S, Almustafa M, Marei Z, Yaghi S, Hababeh L, Al-Gallab N, Al-Jaberi S, Ghattas L, Alrabadi SR, et al. Preoperative Anxiety among Adult Patients Undergoing Elective Surgeries at a Tertiary Teaching Hospital: A Cross-Sectional Study during the Era of COVID-19 Vaccination. Healthcare. 2022; 10(3):515. https://doi.org/10.3390/healthcare10030515
Chicago/Turabian StyleAloweidi, Abdelkarim, Sami Abu-Halaweh, Mahmoud Almustafa, Zaineh Marei, Sara Yaghi, Lina Hababeh, Neebal Al-Gallab, Shatha Al-Jaberi, Lina Ghattas, Sham Romeo Alrabadi, and et al. 2022. "Preoperative Anxiety among Adult Patients Undergoing Elective Surgeries at a Tertiary Teaching Hospital: A Cross-Sectional Study during the Era of COVID-19 Vaccination" Healthcare 10, no. 3: 515. https://doi.org/10.3390/healthcare10030515