Zusammenhang zwischen präoperativer Angst und dem subjektiven Unterstützungsbedarf vor elektiven Eingriffen in Allgemeinanästhesie beim Erwachsenen

Eine Vielzahl an Untersuchungen zeigt, dass eine hohe Prävalenz für präoperative Angst unter Erwachsenen besteht, die sich elektiven Eingriffen in Allgemeinanästhesie unterziehen. So gaben bspw. in einer im Vorfeld im Universitäts-Klinikum Gießen-Marburg (UKGM, Standort Marburg) durchgeführten Studi...

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Bibliographic Details
Main Author: Rienmüller, Stephen
Contributors: Rüsch, Dirk (apl. Prof. Dr. med.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2021
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Table of Contents: It has been shown in many previous studies that preoperative anxiety is a common feeling among adult patients undergoing elective surgery. During a recent study including more than 3000 patients at the Giessen Marburg University Hospital (UKGM), Marburg Campus, more than 90% of the enrolled patients reported preoperative anxiety according to numeric rating scale (NRS, 1–10), leaving less than 10% without preoperative anxiety (NRS = 0). However, it has yet to be examined if preoperative anxiety is associated with a feeling of an emotional distress or bother and if so, to what extent this burden may spring?? provoke a need for assistance in coping with their preoperative anxiety. During the period of one year (November 2017 – October 2018), 1082 adult patients scheduled to undergo elective surgery under general anesthesia were enrolled in the study. Data collection took place during waiting time for the patients’ preoperative assessment at the pre-anesthetic evaluation centers at the UKGM, Marburg Campus. Preoperative anxiety, feelings of emotional distress or bother and need for assistance was assessed using dichotomous questions (yes/no). Preoperative anxiety was measured using a NRS (0-10) and the validated German version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) with a focus on the scores of the anxiety scale (APAIS-A-T, range: 4 - 20). Relationships between APAIS-A-T-scores and both emotional distress or bother and need for assistance were calculated using logistic regression. Data was screened for possible APAIS-A-T-thresholds concerning both emotional distress or bother and need for assistance using both cross tables and receiver operating characteristic (ROC)-analyses. Of the 1082 enrolled patients, 1000 were eligible for data analysis (537 female, 459 male, 4 not specified, age M = 57 years, SD = 18), of which 493 reported preoperative anxiety (318 female; 64,5%, 171 male; 34,7%) Among these 320 patients (64,9%) reported emotional distress or bother caused by their preoperative anxiety, and 291 patients (59%) reported need for assistance. Increasing APAIS-A-T-scores were associated with higher rates of emotional distress or bother (β = 0,407; OR = 1,50; 95% KI: 1,37 – 1,64; p < 0,001) and need for assistance (β = 0,270; OR = 1,31; 95% KI: 1,22 – 1,41; p < 0,001). Interestingly, even lowest anxiety levels (APAIS-A-T = 5 or 6) did not exclude emotional distress or bother and need for assistance. An APAIS-A-T > 9 was identified as best threshold to predict both emotional distress or bother and need for assistance (emotional distress or bother: sensitivity 0,899; specificity 0,755; and need for assistance: sensitivity 0,861; specificity 0,724). Since there is no lower anxiety level (threshold) that reliably identifies neither anxious patients without emotional distress or bother, nor anxious patients without need for assistance, the use of anxiety scoring instruments doesn’t seem to be useful to identify above-mentioned patients. Instead, the use of dichotomous questions seems to be favorable to screen patients for preoperative anxiety, emotional distress or bother and need for assistance. Patients with need for assistance should also be asked whether they want more information about their situation, which would allow identification of their individually preferred coping strategy for further optimization of best individual care.