Skip to main content
Top
Published in: World Journal of Surgery 7/2020

01-07-2020 | Heart Surgery | Original Scientific Report

Factors Associated with High Preoperative Anxiety: Results from Cluster Analysis

Authors: Krzysztof Jarmoszewicz, Katarzyna Nowicka-Sauer, Adam Zemła, Sebastian Beta

Published in: World Journal of Surgery | Issue 7/2020

Login to get access

Abstract

Background

Preoperative anxiety is a common patients’ reaction related to serious adverse events post-operatively. The aim was to explore the characteristics of cardiac surgery patients experiencing high preoperative anxiety.

Methods

A total of 127 patients (mean age 64.48 years; 34.6% women) assessed their level of anxiety while waiting for surgery, need for information, depression and illness perception with the use of Amsterdam Preoperative Anxiety and Information Scale, Visual Analogue Scale, Hospital Anxiety and Depression Scale and Brief Illness Perception Questionnaire, respectively. Clinical and socio-demographic data were gathered using structured interview and medical files review. K-means and hierarchical cluster analyses were performed. α 0.05 was considered significant.

Results

The analysis revealed two different clusters: Cluster 1 involved 46 patients (36.2%; mean age 58.91); Cluster 2 involved 81 patients (63.8%; mean age 67.65). Patients from Cluster 2 had significantly higher anxiety on the day prior to surgery (12.09 vs. 7.93), at a decision stage (6.16 vs. 3.85) and during prehospitalization week (8.01 vs. 4.41). These patients also had more negative illness perception (43.84 vs. 28.35), depressive symptoms (4.9 vs. 2.5) and higher information desire (6.68 vs. 5.54) than patients from Cluster 1. Female sex and planned combined surgery were additional contributors to higher anxiety.

Conclusions

Patients scheduled for cardiac surgery experienced high anxiety throughout the presurgery period. Early intervention addressing not only anxiety but also illness perception and depressive symptoms seems vital. The results can be helpful in planning tailored, needs-based psycho-educational intervention which might improve patients’ preoperative psychological state.
Appendix
Available only for authorised users
Literature
1.
go back to reference Mitchell M (2003) Patient anxiety and modern elective surgery: A literature review. J Clin Nurs 12:806–815CrossRef Mitchell M (2003) Patient anxiety and modern elective surgery: A literature review. J Clin Nurs 12:806–815CrossRef
2.
go back to reference Subramanian M, Kozower BD, Brown LM et al (2019) Patient-reported outcomes in cardiothoracic surgery. Ann Thorac Surg 107:294–301CrossRef Subramanian M, Kozower BD, Brown LM et al (2019) Patient-reported outcomes in cardiothoracic surgery. Ann Thorac Surg 107:294–301CrossRef
3.
go back to reference Roy-Byrne PP, Davidson K, Kessler RC et al (2008) Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 30:208–225CrossRef Roy-Byrne PP, Davidson K, Kessler RC et al (2008) Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry 30:208–225CrossRef
4.
go back to reference Celano CM, Daunis DJ, Lokko HN et al (2016) Anxiety disorders and cardiovascular disease. Curr Psychiatry Rep 18:101CrossRef Celano CM, Daunis DJ, Lokko HN et al (2016) Anxiety disorders and cardiovascular disease. Curr Psychiatry Rep 18:101CrossRef
5.
go back to reference Małyszczak K, Rymaszewska J (2016) Depression and anxiety in cardiovascular disease. Kardiol Pol 74:603–609CrossRef Małyszczak K, Rymaszewska J (2016) Depression and anxiety in cardiovascular disease. Kardiol Pol 74:603–609CrossRef
6.
go back to reference Kindler CH, Harms C, Amsler F et al (2000) The Visual Analog Scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg 90:706–712CrossRef Kindler CH, Harms C, Amsler F et al (2000) The Visual Analog Scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg 90:706–712CrossRef
7.
go back to reference Williams JB, Alexander KP, Morin JF et al (2013) Preoperative anxiety as a predictor of mortality and major morbidity in patients aged %3e 70 years undergoing cardiac surgery. Am J Cardiol 111:137–142CrossRef Williams JB, Alexander KP, Morin JF et al (2013) Preoperative anxiety as a predictor of mortality and major morbidity in patients aged %3e 70 years undergoing cardiac surgery. Am J Cardiol 111:137–142CrossRef
8.
go back to reference Szekely A, Balog P, Benko E et al (2007) Anxiety predicts mortality and morbidity after coronary artery and valve surgery—a 4-year follow-up study. Psychosom Med 69:625–631CrossRef Szekely A, Balog P, Benko E et al (2007) Anxiety predicts mortality and morbidity after coronary artery and valve surgery—a 4-year follow-up study. Psychosom Med 69:625–631CrossRef
9.
go back to reference Caumo W, Schmidt AP, Schneider CN et al (2001) Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand 45:298–307CrossRef Caumo W, Schmidt AP, Schneider CN et al (2001) Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand 45:298–307CrossRef
10.
go back to reference Hernandez-Palazon J, Fuentes-Garcia D, Falcon-Arana L et al (2015) Visual Analogue Scale for anxiety and Amsterdam Preoperative Anxiety Scale provide a simple and reliable measurement of preoperative anxiety in patients undergoing cardiac surgery. Int Cardiovasc Res J 9:1–6 Hernandez-Palazon J, Fuentes-Garcia D, Falcon-Arana L et al (2015) Visual Analogue Scale for anxiety and Amsterdam Preoperative Anxiety Scale provide a simple and reliable measurement of preoperative anxiety in patients undergoing cardiac surgery. Int Cardiovasc Res J 9:1–6
11.
go back to reference Gallagher R, McKinley S (2009) Anxiety, depression and perceived control in patients having coronary artery bypass grafts. J Adv Nurs 65:2386–2396CrossRef Gallagher R, McKinley S (2009) Anxiety, depression and perceived control in patients having coronary artery bypass grafts. J Adv Nurs 65:2386–2396CrossRef
13.
go back to reference Bergmann P, Huber S, Mächler H et al (1999) Perioperative course of stress in patients confronting cardiac surgery. Internet J Anesthesiol 4:1–6 Bergmann P, Huber S, Mächler H et al (1999) Perioperative course of stress in patients confronting cardiac surgery. Internet J Anesthesiol 4:1–6
14.
go back to reference Nowicka-Sauer K, Banaszkiewicz D, Jarmoszewicz K et al (2018) Validation of the Amsterdam Preoperative Anxiety and Information Scale among patients scheduled for cardiac surgery. J Cardiovasc Surg 59:483–485 Nowicka-Sauer K, Banaszkiewicz D, Jarmoszewicz K et al (2018) Validation of the Amsterdam Preoperative Anxiety and Information Scale among patients scheduled for cardiac surgery. J Cardiovasc Surg 59:483–485
15.
go back to reference Schwarze ML, Barnato AE, Rathouz PJ et al (2015) What is high risk surgery? Development of a list of high risk operations for patients age 65 and older. JAMA Surg 150:325–331CrossRef Schwarze ML, Barnato AE, Rathouz PJ et al (2015) What is high risk surgery? Development of a list of high risk operations for patients age 65 and older. JAMA Surg 150:325–331CrossRef
16.
go back to reference Buonanno P, Laiola A, Palumbo Ch et al (2017) Italian validation of the Amsterdam Preoperative Anxiety and Information Scale. Minerva Anestesiol 83:705–711PubMed Buonanno P, Laiola A, Palumbo Ch et al (2017) Italian validation of the Amsterdam Preoperative Anxiety and Information Scale. Minerva Anestesiol 83:705–711PubMed
17.
go back to reference Uzbeck M, Quinn C, Saleem I et al (2009) Randomised controlled trial of the effect of standard and detailed risk disclosure prior to bronchoscopy on peri-procedure anxiety and satisfaction. Thorax 64:224–227CrossRef Uzbeck M, Quinn C, Saleem I et al (2009) Randomised controlled trial of the effect of standard and detailed risk disclosure prior to bronchoscopy on peri-procedure anxiety and satisfaction. Thorax 64:224–227CrossRef
18.
go back to reference Moerman N, van Dam FS, Muller MJ et al (1996) The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg 82:445–451PubMed Moerman N, van Dam FS, Muller MJ et al (1996) The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg 82:445–451PubMed
19.
go back to reference Perks A, Chacravarti S, Manninen P (2009) Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol 21:127–130CrossRef Perks A, Chacravarti S, Manninen P (2009) Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol 21:127–130CrossRef
20.
go back to reference Clatworthy J, Buick D, Hankins M et al (2005) The use and reporting of cluster analysis in health psychology: a review. Br J Health Psychol 10:329–358CrossRef Clatworthy J, Buick D, Hankins M et al (2005) The use and reporting of cluster analysis in health psychology: a review. Br J Health Psychol 10:329–358CrossRef
21.
go back to reference van Giessen A, de Wit GA, Smit HA et al (2016) Patient selection for cardiac surgery: time to consider subgroups within risk categories? Int J Cardiology 203:1103–1108CrossRef van Giessen A, de Wit GA, Smit HA et al (2016) Patient selection for cardiac surgery: time to consider subgroups within risk categories? Int J Cardiology 203:1103–1108CrossRef
22.
go back to reference Guo Q, Lu X, Gao Y et al (2017) Cluster analysis: a new approach for identification of underlying risk factors for coronary artery disease in essential hypertensive patients. Sci Rep 7:43965CrossRef Guo Q, Lu X, Gao Y et al (2017) Cluster analysis: a new approach for identification of underlying risk factors for coronary artery disease in essential hypertensive patients. Sci Rep 7:43965CrossRef
23.
go back to reference Fukuoka Y, Teri C, Lindgren G et al (2007) Cluster analysis: a useful technique to identify elderly cardiac patients at risk for poor quality of life. Qual Life Res 16:1655–1663CrossRef Fukuoka Y, Teri C, Lindgren G et al (2007) Cluster analysis: a useful technique to identify elderly cardiac patients at risk for poor quality of life. Qual Life Res 16:1655–1663CrossRef
24.
go back to reference Ahmad AT, Pencina MJ, Schulte PJ et al (2014) Clinical implications of chronic heart failure phenotypes defined by cluster analysis. J Am Coll Cardiol 64:1765–1774CrossRef Ahmad AT, Pencina MJ, Schulte PJ et al (2014) Clinical implications of chronic heart failure phenotypes defined by cluster analysis. J Am Coll Cardiol 64:1765–1774CrossRef
25.
go back to reference Devon HA, Vuckovic KM (2019) Symptom clusters: is the sum greater than the parts? West J Nursing Research 41:951–953CrossRef Devon HA, Vuckovic KM (2019) Symptom clusters: is the sum greater than the parts? West J Nursing Research 41:951–953CrossRef
26.
go back to reference Nowicka-Sauer K, Banaszkiewicz D, Staśkiewicz I et al (2016) Illness perception in Polish patients with chronic diseases: psychometric properties of the Brief Illness Perception Questionnaire. J Health Psychol 21:1739–1749CrossRef Nowicka-Sauer K, Banaszkiewicz D, Staśkiewicz I et al (2016) Illness perception in Polish patients with chronic diseases: psychometric properties of the Brief Illness Perception Questionnaire. J Health Psychol 21:1739–1749CrossRef
27.
go back to reference Yaraghchi A, Rezaei O, Mandegar MH et al (2012) The relationship between illness perception and quality of life in Iranian patients with coronary artery bypass graft. Procedia Soc Behav Sci 46:3329–3334CrossRef Yaraghchi A, Rezaei O, Mandegar MH et al (2012) The relationship between illness perception and quality of life in Iranian patients with coronary artery bypass graft. Procedia Soc Behav Sci 46:3329–3334CrossRef
28.
go back to reference Nowicka-Sauer K, Jarmoszewicz K, Szyndler K et al (2015) How to express pain and illness? Using drawings to assess pain and illness perception in patients awaiting coronary artery by-pass grafting surgery. Preliminary report Forum Med Rodz 9:288–290 Nowicka-Sauer K, Jarmoszewicz K, Szyndler K et al (2015) How to express pain and illness? Using drawings to assess pain and illness perception in patients awaiting coronary artery by-pass grafting surgery. Preliminary report Forum Med Rodz 9:288–290
29.
go back to reference Carr T, Teucher U, Casson AG (2017) Waiting for scheduled surgery: a complex patients experience. J Health Psychol 2:290–301CrossRef Carr T, Teucher U, Casson AG (2017) Waiting for scheduled surgery: a complex patients experience. J Health Psychol 2:290–301CrossRef
30.
go back to reference Krannich JHA, Weyers P, Lueger S et al (2007) Herzog M, Bohrer T, Elert O. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age. BMC Psychiatry 7:47–52CrossRef Krannich JHA, Weyers P, Lueger S et al (2007) Herzog M, Bohrer T, Elert O. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age. BMC Psychiatry 7:47–52CrossRef
31.
go back to reference Foxwell R, Morley C, Frizelle D (2013) Illness perceptions, mood and quality of life: a systematic review of coronary heart disease patients. J Psychosom Res 75:211–222CrossRef Foxwell R, Morley C, Frizelle D (2013) Illness perceptions, mood and quality of life: a systematic review of coronary heart disease patients. J Psychosom Res 75:211–222CrossRef
32.
go back to reference Juergens MC, Seekatz B, Moosdorf RG et al (2010) Illness beliefs before cardiac surgery predict disability, quality of life, and depression 3 months later. J Psychosom Res 68:553–560CrossRef Juergens MC, Seekatz B, Moosdorf RG et al (2010) Illness beliefs before cardiac surgery predict disability, quality of life, and depression 3 months later. J Psychosom Res 68:553–560CrossRef
33.
go back to reference Monirpoor N, Ali Besharat M, Khoosfi H et al (2012) The role of illness perception in predicting post-CHD depression in patients under CABG and PCI. Procedia Soc Behav Sci 32:74–78CrossRef Monirpoor N, Ali Besharat M, Khoosfi H et al (2012) The role of illness perception in predicting post-CHD depression in patients under CABG and PCI. Procedia Soc Behav Sci 32:74–78CrossRef
34.
go back to reference Rimington H, Weinman J, Chambers JB (2010) Predicting outcome after valve replacement. Heart 96:118–123CrossRef Rimington H, Weinman J, Chambers JB (2010) Predicting outcome after valve replacement. Heart 96:118–123CrossRef
35.
go back to reference Nowicka-Sauer K, Jarmoszewicz K, Trzeciak B et al (2018) Constructivism in patient education—using drawings to explore preconception of coronary artery disease. Kardiol Pol 76:1274–1276CrossRef Nowicka-Sauer K, Jarmoszewicz K, Trzeciak B et al (2018) Constructivism in patient education—using drawings to explore preconception of coronary artery disease. Kardiol Pol 76:1274–1276CrossRef
36.
go back to reference Cameron LD, Leventhal H (2003) The self-regulation of health and illness behaviour. Routledge, New York Cameron LD, Leventhal H (2003) The self-regulation of health and illness behaviour. Routledge, New York
Metadata
Title
Factors Associated with High Preoperative Anxiety: Results from Cluster Analysis
Authors
Krzysztof Jarmoszewicz
Katarzyna Nowicka-Sauer
Adam Zemła
Sebastian Beta
Publication date
01-07-2020
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 7/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-020-05453-x

Other articles of this Issue 7/2020

World Journal of Surgery 7/2020 Go to the issue