COVID-19 Pandemisinde Elektif Cerrahi Uygulanacak Hastaların Preoperatif Anksiyete Düzeylerinin Değerlendirilmesi

Öz

COVID-19 önlemleri alınarak elektif cerrahilerin yeniden başlatıldığı pandemi sürecinde elektif cerrahi uygulanacak hastaların preoperatif anksiyete düzeylerinin ve anksiyete seviyelerini etkileyen faktörlerin değerlendirilmesi amaçlandı. 18-75 yaş grubu elektif cerrahi uygulanacak 450 hasta dahil edildi. Yazılı onamları alınan hastalar preoperatif dönemde değerlendirildi. Demografik verileri, eğitim durumu, medikal geçmişi, anestezi ve cerrahi deneyimleri sorgulandı. COVID-19 hakkında soruların olduğu anket formu ile yirmişer maddelik durumluk ve sürekli kaygı ölçeklerinden oluşan Spielberger Durumluk-Sürekli Anksiyete Ölçeği (STAI) hastalar tarafından dolduruldu. Durumluk (STAI-I) ve sürekli (STAI-II) kaygı ölçeklerinde büyük puan yüksek anksiyete seviyesini, küçük puan ise düşük anksiyete seviyesini belirtir. 49.26±15.51 yaş ortalaması olan hastaların ortalama anksiyete düzeyi STAI-I’de 41.46±8.43, STAI-II’de 37.79±9.73 olarak bulundu. Opere edilen kliniklere göre hastaların STAI-I puanları orta düzeyde anksiyete, STAI-II puanları ise hafif düzeyde anksiyete ile uyumluydu. Hastaların yaşı ile STAI-I arasında negatif yönde korelasyon görüldü (r=-0.52, p=0.136), STAI-II’de ise yaş ile pozitif korelasyon saptandı (r=0.22, p=0.321). Cinsiyet, eğitim durumu, geçirilmiş ameliyat öyküsü ve anestezi deneyimi açısından değerlendirildiğinde preoperatif STAI-I ve II puanlarında farklılık saptanmadı. COVID-19 pandemisi hakkında yeterli bilgi sahibi olmadığını düşünen hastaların (%17,6) STAI-I ve STAI-II puanları anlamlı yüksekti (p= 0.000, p= 0.001). Ailesinde geçirilmiş COVID-19 enfeksiyonu bulunan hastaların STAI-I ve II puanları ile diğer hastaların puanları benzerdi (p=0.76, p=0.91). Hastane yatışında COVID-19 ile enfekte olma tedirginliği bulunan hastaların (287 hasta, %63.8) STAI-I puanı hastanede COVID-19’a yakalanmaktan korkmayanlara (163 hasta, %36.2) göre yüksek bulundu (p=0.05). Postoperatif dönemde hastane yatışı sırasında COVID-19 ile enfekte olan hasta olmadı. Elektif cerrahi geçirecek hastalarda COVID-19 pandemisinde preoperatif anksiyete düzeyleri artmıştır. Preoperatif dönemde hastalara COVID-19 ile ilgili rutin bilgilendirme yapılmasının ve alınacak önlemlerden bahsedilmesinin anksiyete düzeyini azaltmada faydalı olacağı düşüncesindeyiz

Anahtar Kelimeler

• COVID-19
• PANDEMİ
• PREOPERATİF ANKSİYETE
• STAI

Evaluation of Preoperative Anxiety Levels of Patients Undergoing Elective Surgery in COVID-19 Pandemic

Öz

We aimed to evaluate the pre-operative anxiety levels of patients and the factors affecting their anxiety levels who will undergo elective surgery during the pandemic process in which elective surgeries are restarted by taking COVID-19 precautions. 450 patients between 18-75 years old, will undergo elective surgery were included in the study. Patients, whose written consents were obtained, were evaluated in the preoperative period. The demographic data, educational status, medical history, anesthesia and surgical experiences of the patients were questioned. A questionnaire containing questions about COVID-19 and the Spielberger State-Trait Anxiety Inventory (STAI) consisting of twenty-item state and trait anxiety scales were filled in by the patients. On the state (STAI-I) and trait (STAI-II) anxiety scales, a large score indicates a high level of anxiety, and a small score indicates a low level of anxiety. The average anxiety level of the patients with a mean age of 49.26 ± 15.51 years was found as 41.46 ± 8.43 in STAI-I and 37.79 ± 9.73 in STAI-II. According to the type of operation, STAI-I scores of the patients were compatible with moderate anxiety, and STAI-II scores were compatible with mild anxiety. There was a negative correlation between the age of patients and STAI-I scores (r=-0.52, p=0.136). and a positive correlation was found between STAI-II and the age of patients (r = 0.22, p = 0.321). No difference was found in preoperative STAI-I and II scores when evaluated in terms of gender, educational status, history of previous surgery and anesthesia experiences. STAI-I and STAI-II scores were significantly higher in the patients (17.6%) that thought they didn’t have enough information about the pandemic (p = 0.000, p = 0.001). The STAI-I and II scores of the patients with a family history of COVID-19 infection were similar with the other patients (p = 0.76, p = 0.91). The STAI-I scores of the patients (287 pati-ents, 63.8%) who were worried about being infected with COVID-19 during hospitalization were found to be higher than those who were not afraiding of infected with COVID-19 (163 patients, 36.2%) (p = 0.05). There was no patient infected with COVID-19 during hospitalization. Preoperative anxiety levels have increased in patients undergoing elective surgery in COVID-19 pandemic. We think that informing patients about COVID-19 routinely and talking about the precautions to be taken in the preoperative period will be beneficial in reducing their anxiety levels.

Anahtar Kelimeler

• COVID-19
• PANDEMİC
• PREOPERATİVE ANXİETY
• STAI

Kaynakça

1. Mıngır T, Ervatan Z,Turgut N. Spinal anaesthesia and perioperative anxiety. Turk J Anaesth Reanim 2014; 42: 190-5. https://doi.org/10.5152/TJAR.2014.99705.
2. Jlala HA, French JL, Foxall GL, Hardman JG, Bedforth NM. Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesiology. Br J Anaesth 2010;104:369-74. https://doi.org/10.1093/ bja /aeq002.
3. Sigdel S. Perioperative anxiety: a short review. Glob Anaesth Perioper Med. 2015;1(4): 107-108. https://doi.org/10.15761/GAPM.1000126.
4. Erkilic E, Kesimci E, Soykut C, Doger C, Gumus T, Kanbak O. Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara. Patient Prefer Adher. 2017;11:291–6. https://doi.org/10.2147/PPA.S127342.
5. Badner NH, Nielson WR, Munk S, Kwiatkowska C, Gelb AW. Preoperative anxiety: Detection and contributing factors. Can J Anaesth 1990; 37: 444-7.
6. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020;52:102066. https://doi.org/10.1016/j.ajp.2020.102066.
7. Spielberger C. State-trait anxiety inventory: a comprehensive bibliography. 1989, Palo Alto, CA, Mind Garden. pp 4-12.
8. Karadağ ŞA. Ameliyat Öncesi Anksiyetenin APAIS ve STAI-I Ölçekleri İle Değerlendirilmesi. Hacettepe Üniversitesi Hemşirelik Fakültesi Dergisi. 2018; 4(3): 38-47.

9. Demir A, Akyurt D, Ergün B, et al. Anxiety therapy in cardiac surgery patients. Turkish J Thorac Cardiovasc Surg. 2010;18(3):177-82.
10. Domar AD, Everett LL, Keller MG. Preoperative anxiety: Is it a predictable entity? Anesth Analg. l989;69: 763-67.
11. Shevde K, Panagopoulos G. A survey of 800 patients knowledge, attitudes, and concerns regarding anesthesia. Anesth Analg. 1991; 73: 190-98.
12. Won K, Gyeong B, Bong S, Hyeon L. Availability of preoperative anxiety scale as a predictive factor for hemodynamic changes during induction of anesthesia. Korean J. Anesthesiol. 2010;58:328–33, https://doi.org/10.4097/kjae.2010.58.4.328.
13. Sun GC, Hsu MC, Chia YY, Chen PY, Shaw FZ. Effects of age and gender on intravenous midazolam premedication: a randomized double-blind study. Br J Anaesth. 2008;101:632–39. https://doi.org/10.1093 / bja / aen251.
14. Matthias AT, Samarasekera DN. Preoperative anxiety in surgical patients-experience of a single unit. Acta Anaesthesiol Taiwanica. 2012;50(1):3–6. https://doi.org/10.1016/ j.aat.2012.02.004.
15. Perks A, Chakravarti S, Manninen P. Preoperative anxiety in neurosurgical patients. J Neurosurg Anesthesiol. 2009;21(2):127–30.
16. Mulugeta et al. Preoperative anxiety and associated factors among adult surgical patients in Debre Markos and Felege Hiwot referral hospitals, Northwest Ethiopia BMC Anesthesiology. 2018;18:155. https://doi.org/10.1186/12871-018-0619-0.
17. Nigussie S, Belachew T, Wolancho W. Predictors of preoperative anxiety among surgical patients in Jimma University specialized teaching hospital, South Western Ethiopia. BMC Surg. 2014;14(1):1. https://doi.org/10.1186/1471-2482-14-67.
18. Yilmaz M, Sezer H, Gürler H, Bekar M. Predictors of preoperative anxiety in surgical inpatients. J Clin Nurs. 2012;21(7–8):956–64.
19. Wells JK, Howard GS, Nowlin WF, Vargas MJ. Presurgical anxiety and postsurgical pain and adjustment: effects of a stress inoculation procedure. J Consult Clin Psychol. 1986;54(6):831–35.
20. Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani surgical patients. JPMA. 2009;59(6):359-63.
21. Wang TF, Wu YT, Tseng CF, Chou C. Associations between dental anxiety and postoperative pain following extraction of horizontally impacted wisdom teeth. Medicine; 2017;96(47): 8665. https://doi.org/10.1097/MD.0000000000008665.
22. Navarro-Gastón D, Munuera-Martínez PV. Prevalence of preoperative anxiety and ıts relationship with postoperative pain in foot nail surgery: A cross-sectional study. Int J Environ Res Public Health. 2020;22;17(12):4481. https://doi.org/10.3390/ijerph17124481.
23. Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Bandeira D, Ferreira MB. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand. 2001;45(3):298–307.
24. Nomura M, Saeki S, Ogawa S, Tai K, Kajiwara K. Preoperative questionnaire survey about anxiety of patients for scheduled operation Masui. The Japanese Journal of Anesthesiology. 2000;49(8):913-19.
25. Tully PJ, Baker AR, Winefield HR, Turnbull DA. Depression, anxiety disorders and Type D personality as risk factors for delirium after cardiac surgery. Aust NZJ Psychiatry. 2010;44(11):1005-11.
26. Krannich JH, Weyers P, Lueger S, 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. 2007;7:47.
27. Arslan S, Ozer N, Ozyurt F. Effect of music on preoperative anxiety in men undergoing urogenital surgery. AJAN. 2008;26(2), 46–54.
28. Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D. The visual analogue scale allows effective measurement of preoperative anxiety and detection of patient's 2000;90:706-12. https://doi.org/10.1097/ 00000539-200003000-00036.
29. Korukcu O, Ozkaya M, Boran OF, Boran M. The effect of the COVID‐19 pandemic on community mental health: A psychometric and prevalence study in Turkey . Health Soc Care Community. 2020;00:1–10. https://doi.org/10.1111/hsc.13270.
30. Satici B, Gocet TE, Deniz ME, Satici SA. Adaptation of the fear of COVID-19 scale: its association with psychological distress and life satisfaction in Turkey. Int J Ment Health Addict. 2020(5); 8:1-9. https://doi.org/10.1007/s11469-020-00294-0333.
31. Rakhmanov O, Dane S. Knowledge and anxiety levels of African university students against COVID-19 during the pandemic outbreak by an online survey. Int Dent J. 2020;8:53–6.
32. Liu X, Chen M, Wang Y, Sun L, et all. Prenatal anxiety and obstetric decisions among pregnant women in Wuhan and Chongqing during the COVID‐19 outbreak: a cross-sectional study. BJOG. 2020(9);10, 1229-40. https://doi.org/10.1111 / 1471-0528.16381.