Açık Kalp Cerrahisi Geçiren Hastalarda Hastalık Algıları ve Ameliyata Özgü Anksiyete Üzerindeki Etkileri

Öz

Öz Amaç: Bu çalışma, açık kalp cerrahisi planlanan hastalarda hastalık algıları ile ameliyata özgü anksiyete arasındaki ilişkiyi incelemeyi ve ameliyata özgü anksiyetenin temel yordayıcılarını belirlemeyi amaçlamıştır. Gereç ve Yöntem: Tanımlayıcı ve ilişkisel bir araştırma deseni kullanılmıştır. Çalışma Ocak–Eylül 2025 tarihleri arasında yürütülmüştür. Elektif koroner arter baypas grefti (KABG) veya kalp kapak cerrahisi planlanan toplam 120 hasta kolayda örnekleme yöntemiyle çalışmaya dahil edilmiştir. Veriler, kişisel bilgi formu, Hastalık Algısı Anketi (IPQ) ve Ameliyata Özgü Anksiyete Anketi (ASSQ) ile toplanmıştır. Tanımlayıcı istatistikler, Pearson korelasyonu ve çoklu doğrusal regresyon analizleri uygulanmıştır. Bulgular: Katılımcıların yaş ortalaması 62,3±10,4 olup %67,5’i erkekti. Ortalama ASSQ puanı 29,4±5,9 bulunmuş ve bu orta-yüksek düzeyde ameliyata-özgü anksiyeteyi göstermiştir. Çok değişkenli analizde duygusal temsillerin (β=0,60, p<0,001) anksiyetenin en güçlü pozitif yordayıcısı olduğu, tedavi kontrolünün (β=-0,95, p<0,001) ise anksiyete düzeyini anlamlı biçimde azalttığı saptanmıştır. Cinsiyet (erkek: β=-1,92, p=0,029) ve medeni durum (bekar: β=-2,54, p=0,049) da daha düşük anksiyete ile ilişkili bulunmuştur. Son model, ameliyata özgü anksiyetedeki varyansın %49,7’sini açıklamıştır (R²=0,497). Sonuç: Hastalık algıları, özellikle duygusal problemler ve tedavi kontrolüne ilişkin inançlar, açık kalp cerrahisini bekleyen hastalarda ameliyata özgü anksiyetenin temel belirleyicileridir. Bu bulgular, ameliyat öncesi psikolojik değerlendirmenin ve hastalıkla ilişkili duygusal yükü azaltan, hastaların kontrol algısını güçlendiren müdahalelerin gerekliliğini vurgulamaktadır. Bu tür stratejilerin rutin preoperatif bakıma entegre edilmesi, anksiyeteyi azaltmaya ve iyileşme sonuçlarını geliştirmeye katkı sağlayabilir.

Anahtar Kelimeler

• Açık Kalp Cerrahisi
• Hastalık Algısı
• Preoperatif Anksiyete
• Ameliyata Özgü Anksiyete
• Regresyon Analizi.

Illness Perceptions and Their Impact on Surgery-Specific Anxiety in Patients Undergoing Open-Heart Surgery

Öz

Aim: This study aimed to examine the relationship between illness perceptions and surgery-specific anxiety in patients scheduled for open-heart surgery and to identify the key predictors of surgery-specific anxiety. Material and Methods: A descriptive and correlational design was employed. The study was conducted between January and September 2025. A total of 120 patients scheduled for elective coronary artery bypass grafting (CABG) or heart valve surgery were included using convenience sampling. Data were collected via a personal information form, Illness Perception Questionnaire (IPQ), and Anxiety Specific to Surgery Questionnaire (ASSQ). Descriptive statistics, Pearson’s correlation, and multiple linear regression analyses were employed. Results: The mean age of participants was found to be 62.3±10.4, and 67.5% were male. The mean ASSQ score was 29.4±5.9, indicating moderate-to-high surgery-specific anxiety. The multivariate analysis found that emotional representations (β=0.60, p<0.001) were the strongest positive predictor of anxiety, whereas treatment control (β=-0.95, p<0.001) significantly reduced anxiety levels. Gender (male: β=-1.92, p=0.029) and marital status (single: β=-2.54, p=0.049) were also associated with lower anxiety. The final model explained 49.7% of the variance in surgery-specific anxiety (R²=0.497). Conclusion: Illness perceptions, particularly emotional distress and treatment control beliefs are key determinants of surgery-specific anxiety in patients awaiting open-heart surgery. These findings emphasize the need for preoperative psychological assessment and targeted interventions that reduce illness-related emotional burden and strengthen patients’ sense of control. Integrating such strategies into routine preoperative care may help alleviate anxiety and improve recovery outcomes.

Anahtar Kelimeler

• Thoracic Surgery
• Attitude to Health
• Preoperative Care
• Anxiety
• Regression Analysis

Kaynakça

1. WHO. Cardiovascular diseases. Published online 2025. Accessed September 22, 2025. https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
2. Martin SS, Aday AW, Allen NB, et al. 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data from the American Heart Association. Circulation. 2025;151(8):e41-e660.
3. Bueno H, Deaton C, Farrero M, et al. 2025 ESC Clinical Consensus Statement on mental health and cardiovascular disease: developed under the auspices of the ESC Clinical Practice Guidelines Committee. Eur Heart J. Published online August 29, 2025.
4. Bedaso A, Mekonnen N, Duko B. Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: A systematic review and meta-analysis. BMJ Open. BMJ Publishing Group. 2022;12(3).
5. Prado-Olivares J, Chover-Sierra E. Preoperatory Anxiety in Patients Undergoing Cardiac Surgery. Diseases. 2019;7(2):46.
6. Fernández-Castro M, Jiménez JM, Martín-Gil B, et al. The influence of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery. Sci Rep. 2022;12(1).
7. Gorini A, Giuliani M, L’Acqua C, et al. Associations of Preoperative Self-rated Symptoms of Anxiety and Depression on Length of Hospital Stay and Long-term Quality of Life in Patients Undergoing Cardiac Surgery. Journal of Cardiovascular Nursing. 2022;37(3):213-220.
8. Ni K, Zhu J, Ma Z. Preoperative anxiety and postoperative adverse events: a narrative overview. Anesthesiology and Perioperative Science. 2023;1(3).

9. Salzmann S, Salzmann-Djufri M, Wilhelm M, Euteneuer F. Psychological Preparation for Cardiac Surgery. Curr Cardiol Rep. 2020;22(172).
10. Leventhal H, Phillips LA, Burns E. The Common-Sense Model of Self-Regulation (CSM): a dynamic framework for understanding illness self-management. J Behav Med. 2016;39(6):935-946.
11. Lotfi-Tokaldany M, Sadeghian S, Mosavi SA, et al. Association between cognitive representation of illness and the outcome of patients with premature coronary artery disease. J Psychosom Res. 2022;162.
12. Lerdal A, Hofoss D, Gay CL, Fagermoen MS. Perception of illness among patients with heart failure is related to their general health independently of their mood and functional capacity. J Patient Rep Outcomes. 2019;3(1).
13. Mobini S, Allahbakhshian A, Shabanloei R, Sarbakhsh P. Illness Perception, Self-Efficacy, and Medication Adherence in Patients With Coronary Artery Disease: A Path Analysis of Conceptual Model. SAGE Open Nurs. 2023;9.
14. Nur KRM. Illness perception and cardiovascular health behaviour among persons with ischemic heart disease in Indonesia. Int J Nurs Sci. 2018;5(2):174-180.
15. Kidd T, Poole L, Leigh E, Ronaldson A, Jahangiri M, Steptoe A. Health-related personal control predicts depression symptoms and quality of life but not health behaviour following coronary artery bypass graft surgery. J Behav Med. 2016;39(1):120-127.
16. Doering L V., Chen B, Deng M, Mancini D, Kobashigawa J, Hickey K. Perceived control and health-related quality of life in heart transplant recipients. European Journal of Cardiovascular Nursing. 2018;17(6):513-520.
17. Rief W, Shedden-Mora MC, Laferton JAC, et al. Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: Results of the randomized controlled PSY-HEART trial. BMC Med. 2017;15(1).
18. Elm E Von, Egger M, Altman DG, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Br Med J. 2007; 335:806-808.
19. Kang H. Sample size determination and power analysis using the G*Power software. J Educ Eval Health Prof. Korea Health Personnel Licensing Examination Institute. 2021;18.
20. Ladwig KH, Baghai TC, Doyle F, et al. Mental health-related risk factors and interventions in patients with heart failure: a position paper endorsed by the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol. Oxford University Press. 2022;29(7):1124-1141.
21. Weinman J, Petrie KJ, Moss-Morris R, Horne R. The illness perception questionnaire: A new method for assessing the cognitive representation of illness. Psychol Health. 1996;11(3):431-445.
22. Moss-Morris R, Weinman J, Petrie K, Horne R, Cameron L, Buick D. The revised Illness Perception Questionnaire (IPQ-R). Psychol Health. 2002;17(1):1-16.
23. Kocaman N, Özkan M, Armay Z, Özkan S. The reliability and the validity study of Turkish adaptation of the revised Illness Perception Questionnaire. Anatolian Journal of Psychiatry. 2007;8:271-280.
24. Marcil MJ, Houchi C, Nadarajah K, et al. The Influence of Illness Perception and Coping on Anxiety in Adults with Congenital Heart Disease. JACC: Advances. 2023;2(6).
25. O’Connor S, Hevey D, O’Keeffe F. Illness Perceptions, Coping, Health-Related Quality of Life and Psychological Outcomes in Cervical Dystonia. J Clin Psychol Med Settings. 2023;30(1):129-142.
26. Furze G, Dumville JC, Miles JNV, Irvine K, Thompson DR, Lewin RJP. “Prehabilitation” prior to CABG surgery improves physical functioning and depression. Int J Cardiol. 2009;132(1):51-58.
27. Shebl MA, Toraih E, Shebl M, et al. Preoperative anxiety and its impact on surgical outcomes: A systematic review and meta-analysis. J Clin Transl Sci. 2025;9(1).
28. Ramesh C, Nayak BS, Pai VB, et al. Effect of Preoperative Education on Postoperative Outcomes Among Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis. Journal of PeriAnesthesia Nursing. 2017;32(6):518-529.e2.
29. Xue X, Pei W, Jingjing W, Li X, Peng F, Zhinong W. Preoperative individualized education intervention reduces delirium after cardiac surgery: A randomized controlled study. J Thorac Dis. 2020;12(5):2188-2196.
30. Nakamura R, Miyamoto K, Tsuji K, et al. The impact of a preoperative nurse-led orientation program on postoperative delirium after cardiovascular surgery: a retrospective single-center observational study. J Intensive Care. 2023;11(1). doi:10.1186/s40560-023-00666-3
31. Zhuo Q, Ma F, Cui C, et al. Effects of pre-operative education tailored to information-seeking styles on pre-operative anxiety and depression among patients undergoing percutaneous coronary intervention: A randomized controlled trial. Int J Nurs Sci. 2023;10(2):174-181.
32. Abate SM, Chekol YA, Basu B. Global prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and meta-analysis. International Journal of Surgery Open. Elsevier Ltd. 2020;25:6-16.
33. Ramesh C, Nayak BS, Pai VB, George A, George LS, Devi ES. Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study. Int J Afr Nurs Sci. 2017;7:31-36.
34. Rodrigues HF, Furuya RK, Dantas RAS, Dessotte CAM. Anxiety and depression in cardiac surgery: sex and age range differences. Escola Anna Nery - Revista de Enfermagem. 2016;20.
35. Bouchard K, Gareau A, Sztajerowska K, Greenman PS, Lalande K, Tulloch H. Better together: Relationship quality and mental health among cardiac patients and spouses. Fam Process. 2023;62(4):1624-1639.
36. Bidwell JT, Fauer AJ, Howe RJ, et al. Older Adults with Cardiovascular Disease and Their Care Partners: An Analysis of Care Needs, Care Activities, and Care Partner Stress and Mental Health. Journal of Cardiovascular Nursing. Published online 2025.
37. Kutlu MG, Gould TJ. Nicotine modulation of fear memories and anxiety: Implications for learning and anxiety disorders. Biochem Pharmacol. Elsevier Inc. 2015;97(4):498-511.
38. Moylan S, Jacka FN, Pasco JA, Berk M. Cigarette smoking, nicotine dependence and anxiety disorders: A systematic review of population-based, epidemiological studies. BMC Med. 2012;10.