Perioperative Anxiety: Trajectory and Association with Opioid-Related Outcomes

Abstract

INTRODUCTION: Although preoperative anxiety is common, the influence that postoperative anxiety has on postoperative pain and opioid use remains unclear. This study aims to describe the trajectory and association of postoperative anxiety with surgical pain and postoperative opioid use in the 6 months after surgery. METHODS: We conducted a prospective cohort study of 1,771 patients undergoing elective surgeries at a large academic institution. Self-reported opioid use, surgical site pain, and anxiety were recorded on the day of surgery and at 3 follow-up points (1, 3, and 6 months after surgery). We examined postoperative opioid use as the primary outcome in the context of surgical site pain and anxiety using mixed-effects logistic regression models. RESULTS: A total of 30.1% of people reported preoperative anxiety, defined as Patient-Reported Outcomes Measurement Information System (PROMIS) T-Score at or above 55. Anxiety and pain scores were highest on the day of surgery and declined in the months to follow. The odds of opioid use increased by 40% for patients with anxiety (p = 0.026) and 22% for each point increase in pain (p < 0.001; Figure). Those with anxiety also experienced a 1.17-point increase in surgical site pain (p < 0.001). Last, anxiety had no significant mediation effect on the relationship of pain and opioid use, suggesting that anxiety acts as an independent risk factor for increased pain and opioid consumption.FigureCONCLUSION: Anxiety was associated with significant increased surgical site pain and opioid use in the 6 months after surgery. Future studies should investigate the effect of using targeted behavioral therapies to reduce anxiety during the perioperative period.