There are various reasons for surgery: to reduce pain, to improve function, or even to look for a problem. Despite these reasons, “hospitalization and surgery are critical negative life events that lead to the experience of considerable anxiety in patients,” stresses Seifu Nigussie, a researcher from the Department of Nursing at Samara State University. Although nervousness for a life changing event is natural, severe preoperational anxiety can lead to problems such as coughing while receiving anesthesia, more pain, or increased risk of infection.
In his latest study published in the September 2014 edition of BMC Surgery, Nigussie assessed preoperative anxiety in 239 patients scheduled for surgery at Jimma University Specialized Hospital located in Jimma, Ethiopia. Nigussie believes that “understanding this will be important to inform policies and strategies in provision of preoperative anxiety reduction care services.”
Assessing Anxiety Levels in Patients Scheduled for Surgery
The study included patients at the Jimma University Specialized Hospital who were above the age of 15, able to communicate, and scheduled for an upcoming surgery. Those excluded from the study had taken anti-anxiety or anti-depressant medications, or had been diagnosed with an anxiety disorder prior to operation. The 239 patients who qualified were then interviewed to collect sociodemographic data such as:
- Marital status
- Substance use
- Income
- Highest degree of education
In order to measure anxiety levels, Nigussie used the State Trait Anxiety Inventory Scale (STAIS). The STAIS consists of 40 questions designed to differentiate between temporary or state anxiety, and general or long-standing anxiety.
More than Half of All Patients Go into Surgery Anxious
Upon being interviewed, Nigussie discovered that the patients knew very little about their surgery plans. Of the 239 participants, only 125 knew what kind of surgery they would be undergoing. When it came to thinking about their upcoming surgery:
- 168 patients showed strong signs of preoperative anxiety
- 91 patients feared death
- 58 patients feared the unknown
- 47 patients feared financial burden
- 46 patients feared the results of surgery
- 4 patients feared being awake during surgery
Variables that worked to increase preoperative anxiety included:
- Marital status
- Educational status
- Occupation
- Income
- Substance use
- Pain experience
- Knowledge of type of anesthesia
- Time of operation
- Extent of surgery
Out of all these variables, time of operation was the easiest issue to address. Nigussie found that patients who had their surgeries scheduled in the afternoon were 2.8 times less anxious than those with morning surgeries.
Nigussie notes that there is an inverse relationship between preoperative anxiety and receiving preoperative information. This means that patients who know more about their surgery prior to admittance most often have less anxiety. Nigussie attributes this lack of preoperative education to the underdeveloped status of Ethiopia. In theory, if these hospitals could better provide preoperative education, then preoperative anxiety levels in its patients would drastically decrease, resulting in less surgical complications.
Carla Nasca, Ph.D., is a post-doctoral fellow of the American Foundation for Suicide Prevention in the laboratory of Neuroendocrinology at the Rockefeller University, New York. Dr. Nasca received her B.A. in Molecular Biology and her M.S. in Electrophysiology from the University of Palermo in Italy. She earned her Ph.D. in Neurobiology and Pharmacology from the University Sapienza in Rome, Italy, before moving to The Rockefeller University under the mentorship of Dr. Bruce McEwen.
