Abstract
Preoperative anxiety is associated with poor behavioral adherence during anesthetic induction and adverse postoperative outcomes. Research suggests that temperament can affect preoperative anxiety and influence its short- and long-term effects, but these associations have not been systematically examined. To examine the associations of temperament with preoperative anxiety in young patients undergoing surgery. Studies from MEDLINE, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched from database inception to June 2018. All prospective studies reporting associations of temperament with preoperative anxiety were included. Overall, 43 of 5451 identified studies met selection criteria. Using the PRISMA guidelines, reviewers independently read 43 full-text articles, extracted data on eligible studies, and assessed the quality of each study. Data were pooled using the Lipsey and Wilson random-effects model. Primary outcome was the association of temperament with preoperative anxiety in patients undergoing surgery. A total of 23 studies, with 4527 participants aged 1 to 18 years, were included in this review. Meta-analysis of 12 studies including 1064 participants revealed that emotionality (r = 0.11; 95% CI, 0.04 to 0.19), intensity of reaction (r = 0.29; 95% CI, 0.11 to 0.46), and withdrawal (r = 0.40; 95% CI, 0.23 to 0.55) were positively associated with preoperative anxiety, whereas activity level (r = -0.23; 95% CI, -0.31 to -0.16) was negatively correlated with preoperative anxiety. Impulsivity was not significantly associated with preoperative anxiety. This systematic review and meta-analysis provided evidence suggesting that temperament may help identify pediatric patients at risk of preoperative anxiety and guide the design of prevention and intervention strategies. Future studies should continue to explore temperament and other factors influencing preoperative anxiety and their transactional effects to guide the development of precision treatment approaches and to optimize perioperative care.
Highlights
Introduction5 million patients 18 years or younger in North America are at risk of developing preoperative anxiety each year.[4] Preoperative anxiety is associated with important perioperative outcomes, including lengthened period of anesthetic induction and postoperative recovery.[1] Higher levels of preoperative anxiety have been associated with an increased risk of postoperative delirium, anxiety-related negative behavior changes, postoperative pain, and increased analgesia use.[5,6,7,8] Given the adverse psychological and clinical implications of preoperative anxiety, identifying patients at greater risk presents a clinically important opportunity to improve their surgical experience and outcomes
Surgery can be a fearful event for many younger patients, as they face the threat of parental separation, loss of control, pain and discomfort, a strange environment, and uncertainty about the anesthetic procedure.[1,2] The feelings of nervousness, worry, and tension related to an impending surgical experience have been formally recognized as preoperative anxiety,[1,3] which can manifest as crying, anger, behavioral unrest, or verbal unrest.[1]Nearly 5 million patients 18 years or younger in North America are at risk of developing preoperative anxiety each year.[4]
This systematic review and meta-analysis provided evidence suggesting that temperament may help identify pediatric patients at risk of preoperative anxiety and guide the design of prevention and intervention strategies
Summary
5 million patients 18 years or younger in North America are at risk of developing preoperative anxiety each year.[4] Preoperative anxiety is associated with important perioperative outcomes, including lengthened period of anesthetic induction and postoperative recovery.[1] Higher levels of preoperative anxiety have been associated with an increased risk of postoperative delirium, anxiety-related negative behavior changes, postoperative pain, and increased analgesia use.[5,6,7,8] Given the adverse psychological and clinical implications of preoperative anxiety, identifying patients at greater risk presents a clinically important opportunity to improve their surgical experience and outcomes. Such knowledge can help to inform a more appropriate allocation of finite hospital resources to patients who would most benefit from perioperative interventions.[9]
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