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Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study.

ABSTRACT: Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) evaluate any possible factors associated with patients' desire to obtain information related to their heart surgery.This is a prospective observational study for patients already scheduled for cardiac surgery at a core medical institution in Kathmandu, Nepal. We collected sociodemographic and clinical characteristics of the patients from their medical charts, and assessed their preoperative anxiety using the Amsterdam Preoperative Anxiety and Information Scale. We performed descriptive analyses of the collected data. Further, we employed regression models to assess to the objectives of the study.In total, 140 patients participated, and data of 123 (87.9%) were used for analysis. 58.5% of the participants had preoperative anxiety. Female gender (OR 0.31, 95% CI 0.15-0.65, P?

SUBMITTER: Sigdel S

PROVIDER: S-EPMC7478669 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study.

Sigdel Shailendra S Ozaki Akihiko A Basnet Madindra M Kobashi Yurie Y Pradhan Bishwas B Higuchi Asaka A Uprety Anup A

Medicine 20200201 9

Perioperative anxiety could negatively affect surgery outcomes, and cardiac diseases have long been known to be an independent risk factor for anxiety development. However, little is known about preoperative anxiety in Nepalese adult cardiac patients waiting for surgery. The primary objectives of this study were to: (1) clarify the levels of preoperative anxiety in Nepalese adult cardiac patients waiting for open heart surgery; (2) identify factors associated with preoperative anxiety; and (3) e ...[more]

PMID: 32118748

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Project description:BackgroundMajor life changes are among factors that cause anxiety, and one of these changes is surgery. Hospitalization, regardless of disease, is known to provoke anxiety in the patient admitted for surgery. Anxiety is an unpleasant disturbing experience that involves way of thinking of tension, apprehension, uneasiness and high autonomic activity. Patients with high levels of anxiety require higher doses of anesthetic induction agents and recover poorly. The objective of this study was to investigate the prevalence of preoperative anxiety and its predictors among adult patients scheduled for elective surgery.MethodologyInstitutional based cross sectional study was conducted using interviewer administered structured questionnaire in Yirgalem zonal hospital in Ethiopia from November 1, to December 30, 2018 on 407 patients scheduled for elective surgery. The study included all patients with age greater than 18 years who were undergoing surgery. Patients with known anxiety disorder and unable to communicate were excluded from the study. State and trait anxiety inventory (STAI) measurement scale was used to assess preoperative anxiety. Statistical analysis was performed using SPSS version 22. Binary logistic regression analysis was performed to determine the predictors of preoperative anxiety. The strength of the association was presented using AOR with 95% confidence interval and p-value < 0.05 was considered as statistically significant.ResultsAmong a total of 402 patients enrolled in the study 228 (56.7%) were male. The prevalence of preoperative anxiety among scheduled patients for elective surgery was 47.0%. Having strong social support (AOR = .16 CI = 0.07, 0.34), harm from doctor or nurse mistake (AOR = 5.03, CI = 2.85, 8.89), unexpected result of operation (AOR = 3.03, CI = 1.73, 5.19), unable to recover (AOR = 2.96, CI = 1.18, 4.87), and need of blood transfusion (AOR = 2.76, CI = 1.65, 4.62) were significantly associated with preoperative anxiety.ConclusionIn the current study the prevalence of preoperative anxiety was high (47%). Having strong social support, unexpected result of operation, harm from doctor or nurse mistake, need of blood transfusion, and unable to recover were found to be statistically significant for preoperative anxiety. Patients need to be assessed regularly for anxiety during the preoperative visit.

Project description:BackgroundAcute kidney injury (AKI) subtypes combining kidney functional parameters and injury biomarkers may have prognostic value. We aimed to determine whether neutrophil gelatinase-associated lipocalin (NGAL)/hepcidin-25 ratio (urinary concentrations of NGAL divided by that of hepcidin-25) defined subtypes are of prognostic relevance in cardiac surgery patients.MethodsWe studied 198 higher-risk cardiac surgery patients. We allocated patients to four groups: Kidney Disease Improving Global Outcomes (KDIGO)-AKI-negative and NGAL/hepcidin-25 ratio-negative (no AKI), KDIGO AKI-negative and NGAL/hepcidin-25 ratio-positive (subclinical AKI), KDIGO AKI-positive and NGAL/hepcidin-25 ratio-negative (clinical AKI), KDIGO AKI-positive and NGAL/hepcidin-25 ratio-positive (combined AKI). Outcomes included in-hospital mortality (primary) and long-term mortality (secondary).ResultsWe identified 127 (61.6%) patients with no AKI, 13 (6.6%) with subclinical, 40 (20.2%) with clinical and 18 (9.1%) with combined AKI. Subclinical AKI patients had a 23-fold greater in-hospital mortality than no AKI patients. For combined AKI vs. no AKI or clinical AKI, findings were stronger (odds ratios (ORs): 126 and 39, respectively). After adjusting for EuroScore, volume of intraoperative packed red blood cells, and aortic cross-clamp time, subclinical and combined AKI remained associated with greater in-hospital mortality than no AKI and clinical AKI (adjusted ORs: 28.118, 95% CI 1.465-539.703; 3.737, 95% CI 1.746-7.998). Cox proportional hazard models found a significant association of biomarker-informed AKI subtypes with long-term survival compared with no AKI (adjusted ORs: pooled subclinical and clinical AKI: 1.885, 95% CI 1.003-3.542; combined AKI: 1.792, 95% CI 1.367-2.350).ConclusionsIn the presence or absence of KDIGO clinical criteria for AKI, the urinary NGAL/hepcidin-25-ratio appears to detect prognostically relevant AKI subtypes.Trial registration numberNCT00672334, clinicaltrials.gov, date of registration: 6th May 2008, https://clinicaltrials.gov/ct2/show/NCT00672334 . Definition of AKI subtypes: subclinical AKI (KDIGO negative AND Ratio-positive), clinical AKI (KDIGO positive AND Ratio-negative) and combined AKI (KDIGO positive AND Ratio-positive) with urinary NGAL/hepcidin-25 ratio-positive cut-off at 85% specificity for in-hospital death. AKI, acute kidney injury. AUC, area under the curve. NGAL, neutrophil gelatinase-associated lipocalin. KDIGO, Kidney Disease Improving Global Outcomes Initiative AKI definition.

Project description:BackgroundPostoperative delirium (POD) is common and has negative effects on elderly patients. There is a critical need to identify patients at high risk of POD so that providers can better offer targeted interventions in the preoperative and intraoperative periods. We aimed to characterize the prevalence of preoperative anxiety and investigate whether preoperative anxiety predicted the onset of POD in elderly patients undergoing elective orthopedic surgery.MethodsWe conducted a prospective observational cohort study of elderly patients (aged 65 years or older) undergoing elective orthopedic surgery. Preoperative anxiety was assessed using the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), with clinically significant values defined as HADS-A>7. POD was diagnosed according to the Confusion Assessment Method (CAM) criteria on the 5 postoperative days. To determine the independent risk factors for POD, multivariable logistic regression was conducted, including those variables with a p-value <0.05 at univariate analysis.ResultsThere were 263 patients included in the study. Seventy-three (27.8%) patients were diagnosed to be POD. Median duration of delirium was 2 days. Forty (15.2%) patients were assessed to experience preoperative anxiety. The occurrence of preoperative anxiety in total hip arthroplasty (THA), proximal femoral nail antirotation (PFNA), and total knee arthroplasty (TKA) was 12.5%, 16.1%, and 19.5%, respectively. Based on multivariable analysis, only age (odds ratio [OR]= 1.099, 95% Confidence Interval [CI]: 1.013-1.192; P=0.023), Mini Mental State Examination (MMSE) (OR= 0.603, 95% CI: 0.432-0.842; P=0.003) and preoperative anxiety (OR= 3.119, 95% CI: 1.144-8.500; P=0.026) were independently associated with POD.ConclusionIn conclusion, the current study reveals that preoperative anxiety helps to predict the risk of POD in elderly patients undergoing elective orthopedic surgery. Relieving preoperative anxiety could be a new target for preventive interventions to reduce POD.

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Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study.

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Anxiety evaluation in Nepalese adult patients awaiting cardiac surgery: A prospective observational study.

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