Preoperative anxiety and its impact on surgical outcomes: A systematic review and meta-analysis

Abstract

Background: Preoperative anxiety is a common phenomenon affecting 60-80% of surgical patients, with potential implications for surgical outcomes. Despite its prevalence, there remains a lack of consensus on its precise effects and optimal management strategies.

Objective: This meta-analysis aimed to synthesize current evidence on the impact of preoperative anxiety on various surgical outcomes, including anesthetic and analgesic requirements, delirium, recovery times, and pain.

Methods: We conducted a comprehensive literature search and meta-analysis of studies examining the relationship between preoperative anxiety and surgical outcomes. Standardized mean differences (SMD), correlation (COR), and odds ratios (OR) with 95% confidence intervals were calculated.

Results: Our analysis revealed significant associations between preoperative anxiety and increased anesthetic requirements (SMD = 0.67, 95% CI: 0.32-1.01) and analgesic requirements (SMD = 0.89, 95% CI: 0.65-1.12). Preoperative anxiety was associated with postoperative delirium in adults (OR = 1.90, 95% CI: 1.11-3.26), unlike the pediatric population. Preoperative anxiety was associated with prolonged time to reach Modified Aldrete Score of 9 (SMD = 0.79, 95% CI: 0.50-1.07) and extubation time (SMD = 0.89, 95% CI: 0.58-1.21). Preoperative anxiety was positively correlated with propofol consumption (STAI-S COR = 0.35, 95%CI: 0.15-0.55). No significant association between preoperative anxiety and postoperative pain was found.

Conclusions: This meta-analysis provides evidence for the wide-ranging effects of preoperative anxiety on surgical outcomes. The findings emphasize the need for routine preoperative anxiety screening and the development of targeted interventions. Future research should focus on long-term impacts and the effectiveness of various anxiety management strategies.

Keywords: Preoperative anxiety; STAI; delirium; mYPAS; propofol.

Figure 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analysis flow chart of study screening and inclusion.

Figure 2.

Anesthesia-related outcomes. (A) Forest plot of anesthetic drug dose requirements. The x-axis represents the standardized mean difference (SMD) in anesthetic drug dose between anxious and non-anxious patients. (B) Forest plot of analgesic drug dose requirements. The x-axis represents the SMD in analgesic drug dose between anxious and non-anxious patients. For both plots, squares represent individual studies, with size proportional to study weight. Diamond represents the pooled effect size. Horizontal lines represent 95% confidence intervals.

Figure 3.

Postoperative delirium and anxiety scales. Forest plot of postoperative delirium occurrence. The x-axis represents the odds ratio of delirium occurrence in anxious versus non-anxious patients. Squares represent individual studies, with size proportional to study weight. Diamond represents the pooled effect size. Horizontal lines represent 95% confidence intervals.

Figure 4.

Recovery times. (A) Forest plot of time to reach Modified Aldrete Score of 9. (B) Forest plot of extubation time. The x-axis represents the mean difference in minutes between anxious and non-anxious patients. For both plots, squares represent individual studies, with size proportional to study weight. Diamond represents the pooled effect size. Horizontal lines represent 95% confidence intervals.

Figure 5.

(A) Forest plot and meta-analysis of correlation coefficients testing the relationship between pre-op state anxiety (STAI-S scale) and propofol consumption (B) forest plot and meta-analysis of correlation coefficients testing the relationship between preop trait anxiety (STAI-T scale) and propofol consumption. For both plots, squares represent individual studies, with size proportional to study weight. Diamond represents the pooled effect size. Horizontal lines represent 95% confidence intervals.

Figure 6.

Pain (A) forest plot of pain 1h postoperatively (B) forest plot of pain 2h postoperatively (C) forest plot of pain 24h postoperatively. For all plots, squares represent individual studies, with size proportional to study weight. Diamond represents the pooled effect size. Horizontal lines represent 95% confidence intervals.