EVALUATING EFFECTS OF PREOPERATIVE ANXIETY ON PATIENTS’ RECOVERY IN THE BUEA REGIONAL HOSPITAL

Abstract
Background.
Preoperative anxiety is common in patients awaiting surgery. It may lead to a delayed recovery. Medical practitioners are in good position to relieve preoperative anxiety Therefore an assessment of preoperative anxiety and associated factors is a fundamental step for better management of anxious patients.
Objectives: The main objective of this study was to assess the effect of preoperative anxiety on patient’s recovery.
Method: This study was an observational prospective cohort study, which included patients aged 18 years and above admitted for surgery at the Buea regional hospital.

Data collection was done in two phases; the first phase was collected one day before the surgery using the preoperative intrusive thought inventory to assess the presence or absence of anxiety.

The second phase assessed recovery one day, one week and one month after surgery, using the 0 to 10 pain scale, vital signs and physical activity.

Data was coded and exported to statistical package for social science (spss) version 21 for analysis.

The chi square test was us to test for associations between anxiety and its associated factors , as well as anxiety and recovery variables (vital signs, pain and physical activity) using a significance level of <0.005
Results: A greater percentage of the participants were aged 31-40 (34%), and most of the participants were males 46 (57.5%).

A higher percentage of the participants were married 43 (53.8%). 54 68% of the respondents were seen to have preoperative anxiety.

There was a significant relationship (p value=.000) between anxiety, age, gender, medical diagnosis as well as type of surgery.

The results showed no significant relationship between anxiety and vital signs of the participants (p value=.150).

However, there was a significant relationship between preoperative anxiety, postoperative pain and postoperative physical activity.
Conclusions: Most of the patients who awaited surgery in the Buea regional hospital had anxiety.

Preoperative anxiety is associated with factors such as age, gender, medical diagnosis, anxiety and type of surgery.

Postoperative variables such as pain and physical activity are greatly influenced by preoperative physical activity.
CHAPTER ONE
INTRODUCTION
1.1 Background to the study.
Preoperative anxiety is described as an unpleasant state of uneasiness or tension that is secondary to a patient being concerned about a disease, hospitalization, anesthesia, and surgery, or the unknown

(1).A good psychological state is an important health status index. Studies have shown that various psychological factors make up a healthy psychology, such as life satisfaction, social support and optimism, whereas anxiety, stress, depression and hostility reflect a less desirable psychological state which affects ones health in various aspects

(2). The symptoms of preoperative anxiety are the results of the sympathetic, parasympathetic and endocrine systems

(3).Numerous studies have shown the impact of psychological, psychosocial and personality factors on health

(4, 5), and there is evidence that shows that these factors influence a patient’s recovery and survival.

(6, 7). Most of the patients awaiting surgery experience anxiety and perceive the day of surgery as life threatening event

(8). According to literature, 60% -80% preoperative anxiety was reported in the western population

(9, 10).In South Western Ethiopia, the incidence of preoperative anxiety was in between 60-92 % in surgical patients

(11).In Nigeria, the preoperative anxiety in adult patients varies between 11- 80%

(12).The causes of preoperative anxiety may be medical diagnosis, physical separation from family, hospitalization, preoperative instructions including fasting period and other physical preoperative preparation, no or little knowledge about diagnosis, surgical interventions, or therapeutic methods, operating room environment and the patients may also worry about anesthesia, success of surgery, post-operative pain management and high costs of operation

(13). The anxiety starts at the time of being scheduled for surgery for most patients and increases to a peak level at the time of admission for surgery

(14, 15).Previous studies have reported that preoperative anxiety affects the path of surgery beginning from difficulty in the insertion of intravenous catheter in the preoperative phase as it is associated with vasoconstriction

(16), it is also associated with hypertension and increased heart rate.
In addition, anxiety may determine increased intraoperative anesthetic requirements

(17) and more frequent demands of analgesics in patient-control analgesia postoperatively

(18) and may thus produce a lower level of satisfaction with the treatment.
It has also been stated that psychology could influence wound healing and surgical recovery directly through its effects on stress hormones such as cortisol, adrenaline and noradrenaline which regulate healing

(19, 20).In addition, (21) it was discovered that preoperative anxiety was an independent predictor of postoperative mortality or major morbidity in patient who had cardiac surgery.

Furthermore it was reported that preoperative anxiety strongly predicts anxiety six months postoperatively which was associated with poorer health outcomes in patients who underwent coronary artery bypass grafting surgery

(22). Also, preoperative anxiety is associated with an increase in pain perception, nausea, and vomiting after surgery, and it also correlates with long hospital stay, and high health care cost

(11, 23, 24).The information and education provided to patients during consultation and before surgery, as well as the respect and empathy of nurses towards the patients and openness of nurses to the patients’ concerns positively aids to alleviate anxiety level of the patients awaiting surgery.
High anxiety decreases the confidence of the patients and family members to participate in care

(25). The operating room environment also affects the patient anxiety, the sound of alarms of machines, and instruments, and different unusual instruments, equipment, and attires may increase the anxiety levels of the patients as well (24, 25).
The success of preoperative anxiety management may result in quick recovery, short hospital stay, fewer complications, less post-operative analgesic demands, and improved patient’s compliance thus the surgical care becomes more economical and satisfying

(26).Assessing patients for psychological preparedness before surgery can help get information about the patient’s beliefs and other factors of stress, anxiety and depression which may affect postoperative recovery and also length of hospital stay.

When a perioperative nurse is providing an education and psychological support, the patient gets an opportunity to express his/her thoughts, feelings and their expectations which increase the patient’s confidence in the surgical team (24).
Therefore, anxiety as nursing diagnosis in patient awaiting surgery may best be investigated and managed by nurses before the surgery (26, 27) as a decrease in the anxiety levels results in the smooth running of the surgical process, enhanced postoperative healing process, low health care cost and patients satisfaction with the surgical care (24, 25).

The preoperative detection of the level of anxiety and identification of associated factors are crucial for better preoperative anxiety management that results in a better surgical outcome, patient satisfaction and low health care cost with increased productivity. (28)
1.2 Problem Statement
Preoperative psychological status has been recognized to play a big role in postoperative recovery.

Preoperative anxiety is an important predictor to recovery and can affect the patient for up to two years post surgically (29, 30).

Studies have shown that mental health is one of the most overlooked factors in daily clinical practice, and the patient’s psychology affects postoperative recovery in terms of pain perception, return to work and quality of life (31).
However, the preoperative anxiety levels of patients waiting for surgery in Buea regional Hospital is not well documented.

Therefore for the purpose of smoothly running the surgical process which results in positive surgical outcomes, the nurse needs to assess preoperative anxiety level and associated factors in order to intervene effectively.
1.3 Justification of the Study
Mental health in general has been viewed as a neglected area, and one in which patients may be less likely to have a voice when it comes to their safety (32).

Some patients have a longer recovery period because of the poor preoperative psychological preparation.

This study may provide adequate information on the effect of preoperative anxiety of the patients’ and its relationship with the patient’s recovery.
1.4 Goal of the Study
The goal of this study is to assess the effect of preoperative anxiety of patients admitted for surgery on their postoperative recovery.
1.5 Main Objectives
To assess the effect of preoperative anxiety on recovery among patients awaiting surgery in the Buea regional hospital.
1.6 Specific Objectives
To determine the levels of preoperative anxiety of patients awaiting surgery at Buea regional hospital
To determine the factors associated with preoperative anxiety.
To assess the relationship between preoperative anxiety, and its associated factors as well as recovery