Preoperative anxiety in patients posted first in operating list to patients posted late in operating list: A randomized control trial

Swati Singh; Manisha Sharma; Swati Singh

ORIGINAL ARTICLE

Year : 2020 | Volume : 6 | Issue : 1 | Page : 31-33

Preoperative anxiety in patients posted first in operating list to patients posted late in operating list: A randomized control trial

Swati Singh¹, Manisha Sharma², Swati Singh³
¹ Associate Professor, Dept. of Anesthesiology, IGIMS, Patna, India
² Senior Resident, Dept. of Anesthesiology, IGIMS, Patna, India
³ Assistant Professor, Dept. of Anesthesiology, IGIMS, Patna, India

Date of Submission	21-Nov-2019
Date of Acceptance	08-Jan-2020
Date of Web Publication	12-Feb-2020

Correspondence Address:
Manisha Sharma
Senior Resident, Dept. of Anaesthesiology, IGIMS, Patna
India

Source of Support: None, Conflict of Interest: None

Abstract

Background: Preoperative anxiety is not uncommon in patients posted for surgery. The relative position of patients in operating list can be one of the cause of anxiety.
Aim: To compare anxiety in patients posted first in operating list to patients posted late in operating list.
Materials & Methods: The influence of the relative position in the operating list on pre-operative anxiety was studied in 400 American Society of Anesthesiologist grade 1 patients undergoing major surgery. Two hundred patients were placed first on the operating list (group 1) and 200 were given a time 5 hour later (group 2). Each patient was visited on the evening prior to surgery and again on the morning of surgery. Anxiety was measured at each visit by objective criteria and part 1 of the State-Trait Anxiety Inventory (STAI) questionnaire.
Results: In both groups the pulse rate, systolic blood pressure , respiratory rate and STAI questionnaire score were significantly higher on the morning of surgery than on the evening prior to surgery(p<0.05). The increase in pulse rate and systolic blood pressure, respiratory rate was comparable in the two groups. The evening anxiety scores were not correlated with those on the morning visit and could not predict them.
Conclusion: There is no effect on anxiety status of the patient due to relative position of patient in operating list.

Keywords: Preoperative; anxiety; surgery; heart rate; questionnaire.

How to cite this article:
Singh S, Sharma M, Singh S. Preoperative anxiety in patients posted first in operating list to patients posted late in operating list: A randomized control trial. J Indira Gandhi Inst Med Sci 2020;6:31-3

How to cite this URL:
Singh S, Sharma M, Singh S. Preoperative anxiety in patients posted first in operating list to patients posted late in operating list: A randomized control trial. J Indira Gandhi Inst Med Sci [serial online] 2020 [cited 2023 Mar 27];6:31-3. Available from: http://www.jigims.co.in/text.asp?2020/6/1/31/300735

Introduction

Preoperative anxiety and stress are common in surgical patients.^[1] Patients particularly are very worried about postoperative pain, intraoperative awareness and waiting for surgery.^[1],[2] Most of the surgeons have long operating list which may lead to cancellation of patients posted late in operating list (OT).^[3] This risk of surgery getting postponed add to the burden of stress among these patients.^[3],[4] Haemodynamic stress responses such as increased heart rate and arterial pressure are triggered by endocrine regulatory mechanism and autonomic nervous system.^[4],[5] This may be deleterious in particular group of patient leading to cardiac excitability resulting in arrhythmias, increased postoperative pain and prolonged hospital stay. Thus it is always necessary to understand these risk factors and try to do things necessary to alleviate these risk.^[6] This study was designed to assess the influence of patient positioning in OT list on preoperative anxiety

Materials and Methods

A prospective, clinical investigation was carried out in 400 patients, aged between 20 and 60 years , who were to undergo any major surgery between march 2017 and November 2018. The institutional ethics committee approval (memo no. 1282/Acad dated 30.11.2016) was obtained before starting the study. All the patients with major systemic or malignant disease, psychiatric illness, drug addiction or previous exposure from anaesthesia were excluded. All the patients who gave written informed consent for the participation in the study were allocated into two groups. Two hundred were placed first on the operating list (group1) and 200 in the later part (group2). Each patients had two preoperative visit , once on the evening prior to the surgery and second time on the morning of surgery and were assured that they definitely would get operated. Any delay in their respective time in operating room would be conveyed to the patient. Anxiety was measured during each visit by objective criteria [Table 1] and a self-evaluation psychological questionnaire consisting of part 1 of the State-Trait Anxiety Inventory (STAI)^[7] to measure state anxiety, i.e. anxiety at that particular moment. Scoring of the questionnaire was done under the supervision of a qualified psychologist. Analysis of the data was performed using paired and unpaired t-tests and Wilcoxon’s rank sum test. A value of p < 0.05 was considered statistically significant. Spearman’s rank correlation analysis was performed to detect any relation between the STAI scores of the evening before and the morning of surgery.

Table 1: The values of the objective criteria on the evening before and on the morning of surgery and their mean rise in patients placed early (group 1) and late (group 2) in the operating list. Values are expressed as mean (SD).* p<0.05 for intragroup comparison between previous night and morning of surgery (Student’s paired t-lest. compared to the value on the previous evening in the same group).

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Results

All 400 patients recruited for the study completed the study as seen in the Consolidated Standards of Reporting Trials (CONSORT) diagram. (Fig. 1) The two groups were comparable in age, sex, American society of anesthesiologist grading (ASA) and type of surgery. In both groups, the pulse rate, systolic blood pressure and respiratory rate was significantly higher on the morning of surgery than on evening (p < 0.05). There was similar increase seen in both the group. [Table 1]

On the morning of surgery both groups had higher STAI scores as compared to the previous evening (p < 0.05). But there was no significant difference in STAI score between both the group in both evening and morning of surgery. [Table 2]

Table 2: State Trait Anxiety Inventory Scores in patients placed early (group 1) and late (group 2). Values are expressed as median (interquartile range). * p < 0.05 on intragroup comparison Wilcoxon’s rank sum test.

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Discussion

It is difficult to measure anxiety as it is an emotion. Objective criteria (heart rate, systolic blood pressure, pulse rate, respiratory rate and hormonal levels) has been considered better than subjective criteria for assessing anxiety since they are not associated with observer bias. But they may be fallacious in patients suffering from systemic diseases such as hypertension, cardiac rhythm disturbances or some endocrine disorders etc.^[8]

Self assessment by questionnaire method has been supported by many authors as a sensitive and accurate method of measurement of anxiety. We have used in our study along with objective measures, a standardized scale, Spielberger’s State-Trait Anxiety Inventory, which has been used previously to demonstrate the heightened level of pre-operative anxiety.9, 10, 11 Part I of this questionnaire contains 20 questions phrased in simple English and measures state anxiety.

There are many factors responsible for preoperative fears, of which some are avoidable with an informative preanaestheti’c evaluation. If patients are informed about type of surgery, anaesthesia, time of shifting to the operating room and how many minimum hours nil per oral (NPO) required, then definitely their anxiety level will reduce.

We found out that irrespective of position in the operating room all the patients had a high level of anxiety on the morning of surgery compared to previous evening. There was no difference in the level of anxiety by respective placement (early or late) in the operating list. This result was different from an earlier similar study by Panda et al in which placement in OT list had significant effect on level of anxiety.^[8] This difference may be due to more informative communications with the patients during preanesthetic visits. The other reason may be due to difference in the sample size. They had taken total 60 patients and we had 200 patients in both the group. Every patient were explained in preanaesthetic check up about tentative time of surgery and hours of NPO status required. Since these two factors were found to be major contributor in preoperative anxiety. Soni and Thomas have found a positive correlation between waiting time and the final linear analogue anxiety score.^[1] The second highest distress rating observed by Cobley et al was in response to not being allowed to drink.^[2] Patients who were posted late in operating list were kept NPO according to their tentative time and were shifted to the waiting area only when the previous case had finished. All patients were timely informed in case of any unforeseen delays in their tentative operating time by the nursing staffs. Thus a required communication was continuously maintained with the patients. If these two factors were managed properly as in our case then relative positioning of patient was not increasing the level of anxiety in our study. Fear of postponement of surgery due to lack of time should be minimized during preanaestheti’c visit.^{[7],[12],[13]} Patients should be told the approximate time of surgery during the pre- anaesthetic assessment. In case of a possibility of delay in surgery, the patient should be informed about it well in advance, along with the reasons. Patients listed in the later part of the operating list should not be asked to fast for more than 6 h, thus avoiding a dry mouth, thirst and excessive anxiety. The list of patients posted for the surgery should be prepared logically.

Conclusion

Pre-operative anxiety tends to increase in all patients on the morning of surgery as compared to that on the evening prior to surgery. Placing the patient in the later part of the operating list does not increases the degree of anxiety in the patient awaiting surgery with more informative preanaestheti’c visits by the anaesthetists.

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