Influence of Preoperative Anxiety on Postoperative Opioid Consumption and Pain Scores in Adults Undergoing Elective Cardiac Surgery.

OBJECTIVES

To evaluate whether preoperative anxiety was associated with higher opioid consumption and higher pain scores after cardiac surgery.

DESIGN

A prospective cohort study.

SETTING

University hospital, single-center study.

PARTICIPANTS

A total of 220 adult patients undergoing their first elective cardiac surgery by sternotomy.

INTERVENTIONS: Preoperative anxiety (A) was assessed the day before surgery using the Hospital Anxiety and Depression Scale (HADS). In-hospital opioid consumption and daily assessments of postoperative pain using a visual analog scale (VAS) were performed until 5 days after surgery. A HADS-A score of >7 of 21 was considered abnormal.

MEASUREMENTS AND MAIN

RESULTS

Patients with or without anxiety were compared using the Mann-Whitney U test and the chi-square test. Linear regression analyses assessed the relationship between preoperative anxiety and postoperative opioid consumption, as well as VAS scores, at day (D) 1, D2, and D5. Of the patients, 186 of 220 (84.5%) completed the HADS-A, and 90 of 186 (48.4%) had preoperative signs of anxiety. There was no significant difference in terms of age between patients with and without anxiety. Twenty of 31 female patients (64.5%) had anxiety versus 70 of 155 men (45.2%) (p = 0.049). There was no difference in in-hospital opioid consumption (p = 0.311). However, anxious patients described significantly higher VAS scores at several moments from D1 to D5 after surgery.

CONCLUSIONS

A significant proportion of our cardiac surgery patients, especially women, experienced preoperative anxiety. Although the latter did not influence in-hospital opioid consumption, anxiety had a significant impact on postoperative VAS pain scores. Screening and management of anxiety before elective cardiac surgery could improve postoperative recovery by reducing pain severity.