open access

Vol 51, No 1 (2019)
Review articles
Published online: 2019-03-21
Submitted: 2018-11-28
Accepted: 2019-02-19
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Measures of preoperative anxiety

Adam Jarosław Zemła, Katarzyna Nowicka-Sauer, Krzysztof Jarmoszewicz, Kamil Wera, Sebastian Batkiewicz, Małgorzata Pietrzykowska
DOI: 10.5603/AIT.2019.0013
·
Anaesthesiol Intensive Ther 2019;51(1):64-69.

open access

Vol 51, No 1 (2019)
Review articles
Published online: 2019-03-21
Submitted: 2018-11-28
Accepted: 2019-02-19

Abstract

The evaluation of treatment from the patient’s perspective (Patient Reported Outcomes, PROs) currently remains one of the most vibrant and dynamically developing fields of research. Among PROs, patient self-assessment of various symptoms, including one’s psychological state, is of great importance. Anxiety is one of the most frequently observed psychological reactions among patients awaiting various surgeries, and may occur even in up to 80% of patients scheduled for high-risk surgical procedures. An increased level of preoperative anxiety has been proved to be related to negative consequences, both psychological and somatic, and affecting, in consequence, anaesthesia, postoperative care and treatment, along with the rehabilitation process. It is also considered as a risk factor for mortality in patients after surgeries. Planning of necessary educational, pharmacological and psychological interventions should be preceded by the evaluation of anxiety level which should be considered a routine element of preoperative care. The assessment of anxiety intensity may be performed using psychometric scales. Various factors should be taken into consideration while choosing the scale, including its reliability and accuracy, the aim of the assessment, the patient’s age and clinical state, as well as the type of surgery being planned. In the current article, we present standardised and reliable methods which may be used in the evaluation of preoperative anxiety among patients scheduled for surgery, namely: the State-Trait Anxiety Inventory (STAI); the Hospital Anxiety and Depression Scale (HADS); the Amsterdam Preoperative Anxiety and Information Scale (APAIS); and the Visual Analogue Scale (VAS). A detailed description of the scales, including their main advantages and limitations, as well as their usefulness in both clinical evaluation of various patients’ groups and scientific research are presented.

Abstract

The evaluation of treatment from the patient’s perspective (Patient Reported Outcomes, PROs) currently remains one of the most vibrant and dynamically developing fields of research. Among PROs, patient self-assessment of various symptoms, including one’s psychological state, is of great importance. Anxiety is one of the most frequently observed psychological reactions among patients awaiting various surgeries, and may occur even in up to 80% of patients scheduled for high-risk surgical procedures. An increased level of preoperative anxiety has been proved to be related to negative consequences, both psychological and somatic, and affecting, in consequence, anaesthesia, postoperative care and treatment, along with the rehabilitation process. It is also considered as a risk factor for mortality in patients after surgeries. Planning of necessary educational, pharmacological and psychological interventions should be preceded by the evaluation of anxiety level which should be considered a routine element of preoperative care. The assessment of anxiety intensity may be performed using psychometric scales. Various factors should be taken into consideration while choosing the scale, including its reliability and accuracy, the aim of the assessment, the patient’s age and clinical state, as well as the type of surgery being planned. In the current article, we present standardised and reliable methods which may be used in the evaluation of preoperative anxiety among patients scheduled for surgery, namely: the State-Trait Anxiety Inventory (STAI); the Hospital Anxiety and Depression Scale (HADS); the Amsterdam Preoperative Anxiety and Information Scale (APAIS); and the Visual Analogue Scale (VAS). A detailed description of the scales, including their main advantages and limitations, as well as their usefulness in both clinical evaluation of various patients’ groups and scientific research are presented.

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Keywords

preoperative anxiety, assessment methods

About this article
Title

Measures of preoperative anxiety

Journal

Anaesthesiology Intensive Therapy

Issue

Vol 51, No 1 (2019)

Pages

64-69

Published online

2019-03-21

DOI

10.5603/AIT.2019.0013

Bibliographic record

Anaesthesiol Intensive Ther 2019;51(1):64-69.

Keywords

preoperative anxiety
assessment methods

Authors

Adam Jarosław Zemła
Katarzyna Nowicka-Sauer
Krzysztof Jarmoszewicz
Kamil Wera
Sebastian Batkiewicz
Małgorzata Pietrzykowska

References (45)
  1. Bansal T, Joon A. Preoperative anxiety-an important but neglected issue: A narrative review. The Indian Anaesthetists' Forum. 2016; 17(2): 37.
  2. Hernández-Palazón J, Fuentes-García D, Falcón-Araña L, et al. Assessment of preoperative anxiety in cardiac surgery patients lacking a history of anxiety: contributing factors and postoperative morbidity. J Cardiothorac Vasc Anesth. 2018; 32(1): 236–244.
  3. Ortiz J, Wang S, Elayda MA, et al. Preoperative patient education: can we improve satisfaction and reduce anxiety? Rev Bras Anestesiol. 2015; 65(1): 7–13.
  4. Ramesh C, Nayak B, Pai V, et al. Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study. International Journal of Africa Nursing Sciences. 2017; 7: 31–36.
  5. Zimecki M, Artym J, Chodaczek G, et al. The effect of psychic stress on the immune response. Postepy Hig Med Dosw (Online). 2004; 58(6): 166–175.
  6. Ziętek P, Ziętek J, Szczypiór K. Anxiety in patients undergoing fast-track knee arthroplasty in the light of recent literature. Psychiatria Polska. 2014; 48: 1015–1024.
  7. Kil HK, Kim WO, Chung WY, et al. Preoperative anxiety and pain sensitivity are independent predictors of propofol and sevoflurane requirements in general anaesthesia. Br J Anaesth. 2012; 108(1): 119–125.
  8. Hasiak J. Stres okołooperacyjny. Część I: Geneza. Przegląd Urologiczny. 2012; 72: 19–23.
  9. Ziębicka J, Gajdosz R. Wybrane aspekty lęku u chorych oczekujących na operację. Anest Intens Ter. 2006; 1: 41–44.
  10. Greszta E, Siemińska MJ. Poziom lęku-stanu i lęku-cechy u pacjentów zakwalifikowanych do leczenia operacyjnego pomostowaniem aortalno-wieńcowym a percepcja bólu rany pooperacyjnej i innych dolegliwości bólowych. Ann Acad Med Stetin. 2008; 54: 157–163.
  11. Bradshaw P, Hariharan S, Chen D. Does preoperative psychological status of patients affect postoperative pain? A prospective study from the Caribbean. Br J Pain. 2016; 10(2): 108–115.
  12. Navarro-García MA, Marín-Fernández B, de Carlos-Alegre V, et al. Preoperative mood disorders in patients undergoing cardiac surgery: risk factors and postoperative morbidity in the intensive care unit. Rev Esp Cardiol. 2011; 64(11): 1005–1010.
  13. Schwartz-Barcott D, Fortin J, Kim H. Client-nurse interaction: Testing for its impact in preoperative instruction. International Journal of Nursing Studies. 1994; 31(1): 23–35.
  14. Ali A, Lindstrand A, Sundberg M, et al. Preoperative anxiety and depression correlate with dissatisfaction after total knee arthroplasty: a prospective longitudinal cohort study of 186 patients, with 4-year follow-up. J Arthroplasty. 2017; 32(3): 767–770.
  15. Bovaira M, Herrero Babiloni A, Jovaní M, et al. Relationship between preoperative anxiety and postoperative satisfaction in dental implant surgery with intravenous conscious sedation. Med Oral Patol Oral Cir Bucal. 2010; 15(2): e379–e382.
  16. Cserép Z, Losoncz E, Balog P, et al. The impact of preoperative anxiety and education level on long-term mortality after cardiac surgery. J Cardiothorac Surg. 2012; 7: 86.
  17. Székely A, Balog P, Benkö E, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study. Psychosom Med. 2007; 69(7): 625–631.
  18. Williams JB, Alexander KP, Morin JF, et al. Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. Am J Cardiol. 2013; 111(1): 137–142.
  19. Mercieca-Bebber R, King MT, Calvert MJ, et al. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Relat Outcome Meas. 2018; 9: 353–367.
  20. Rumsfeld J, Alexander K, Goff D, et al. Cardiovascular health: the importance of measuring patient-reported health status. Circulation. 2013; 127(22): 2233–2249.
  21. Rumsfeld J, Alexander K, Goff D, et al. Cardiovascular health: the importance of measuring patient-reported health status. Circulation. 2013; 127(22): 2233–2249.
  22. Wrześniewski K, Sosnowski T, Jaworowska A, Fecenec D. Inwentarz Stanu i Cechy Lęku STAI: polska adaptacja. Podręcznik. Pracownia Testów Psychologicznych, Warszawa 2006.
  23. Kvaal K, Ulstein I, Nordhus IH, et al. The Spielberger State-Trait Anxiety Inventory (STAI): the state scale in detecting mental disorders in geriatric patients. Int J Geriatr Psychiatry. 2005; 20(7): 629–634.
  24. Kindler CH, Harms C, Amsler F, et al. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients' anesthetic concerns. Anesth Analg. 2000; 90(3): 706–712.
  25. Millar K, Jelicic M, Bonke B, et al. Assessment of preoperative anxiety: comparison of measures in patients awaiting surgery for breast cancer. Br J Anaesth. 1995; 74(2): 180–183.
  26. Pawlak A, Krejca M, Janas-Kozik M, et al. Ocena leku i depresji w okresie okołooperacyjnym u pacjentów poddawanych rewaskularyzacji mięśnia sercowego. Psych Pol. 2012; 66: 63–74.
  27. Nishimori M, Moerman N, Fukuhara S, et al. Translation and validation of the Amsterdam preoperative anxiety and information scale (APAIS) for use in Japan. Qual Life Res. 2002; 11(4): 361–364.
  28. Kiyohara LY, Kayano LK, Oliveira LM, et al. Surgery information reduces anxiety in the pre-operative period. Rev Hosp Clin Fac Med Sao Paulo. 2004; 59(2): 51–56.
  29. Fathi M, Alavi SM, Joudi M, et al. Preoperative anxiety in candidates for heart surgery. Iran J Psychiatry Behav Sci. 2014; 8(2): 90–96.
  30. Detroyer E, Dobbels F, Verfaillie E, et al. Ispreoperative anxiety and depression associated with onset of delirium after cardiac surgery in older patients? a prospective cohort study. Journal of the American Geriatrics Society. 2008; 56(12): 2278–2284.
  31. Maurice-Szamburski A, Bruder N, Loundou A, et al. Development and validation of a perioperative satisfaction questionnaire in regional anesthesia. Anesthesiology. 2013; 118(1): 78–87.
  32. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983; 67: 361–370.
  33. Roberts SB, Bonnici DM, Mackinnon AJ, et al. Psychometric evaluation of the Hospital Anxiety and Depression Scale (HADS) among female cardiac patients. Br J Health Psychol. 2001; 6(Part 4): 373–383.
  34. Duivenvoorden T, Vissers MM, Verhaar JAN, et al. Anxiety and depressive symptoms before and after total hip and knee arthroplasty: a prospective multicentre study. Osteoarthritis Cartilage. 2013; 21(12): 1834–1840.
  35. Bunevicius A, Deltuva VP, Tamasauskas A. Association of pre-operative depressive and anxiety symptoms with five-year survival of glioma and meningioma patients: a prospective cohort study. Oncotarget. 2017; 8(34): 57543–57551.
  36. Liu XY, Ma YK, Zhao JC, et al. Risk factors for preoperative anxiety and depression in patients scheduled for abdominal aortic aneurysm repair. Chin Med J (Engl). 2018; 131(16): 1951–1957.
  37. Wood TJ, Thornley P, Petruccelli D, et al. Preoperative predictors of pain catastrophizing, anxiety, and depression in patients undergoing total joint arthroplasty. J Arthroplasty. 2016; 31(12): 2750–2756.
  38. Nishimori M, Moerman N, Fukuhara S, et al. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg. 1996; 82(3): 445–451.
  39. Nowicka-Sauer K, Banaszkiewicz D, Jarmoszewicz K, et al. Validation of the Amsterdam Preoperative Anxiety and Information Scale among patients scheduled for cardiac surgery. J Cardiovasc Surg (Torino). 2018; 59(3): 483–485.
  40. Derewianka-Polak M, Polak G, Bobiński M, et al. Evaluation of a level of preoperative anxiety in patients undergoing gynaecological surgeries. Gin Pol Med Project. 2016; 40: 29–34.
  41. Pieniążek B, Rachwał S, Kübler A. Wykorzystanie oceny stopnia niepokoju i oczekiwań przedoperacyjnych oraz akceptacji zabiegu dla oszacowania jakości usług anestezjologicznych. Anest Int Ter. 2007; 2: 85–89.
  42. 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.
  43. Nowicka-Sauer K, Jarmoszewicz K, Trzeciak B, et al. Constructivism in patient education: using drawings to explore preconception of coronary artery disease. Kardiol Pol. 2018; 76(8): 1274–1276.
  44. Sobczak K, Leoniuk K, Janaszczyk A. Delivering bad news: patient's perspective and opinions. Patient Prefer Adherence. 2018; 12: 2397–2404.
  45. Shafer A, Fish MP, Gregg KM, et al. Preoperative anxiety and fear: a comparison of assessments by patients and anesthesia and surgery residents. Anesth Analg. 1996; 83(6): 1285–1291.

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