Surgical-associated anxiety and postoperative anesthesia recovery among elderly patients subjected to laparoscopic abdominal surgeries: The impact of educationalbased intervention

Abstract

Background: Considerable number of elderly patients still experience preoperative anxiety and poor postoperative anesthesia recovery, despite magnitude advances in laparoscopic management and improved anesthetic techniques, resulted from many improper connotations such as the complexity of anesthesia and surgery, fear of experiencing pain, physiologic response, patient unique characteristics, or being improperly informed. To date, anxiety and recovery in an elderly population undergoing laparoscopic abdominal surgeries have received very little attention and interventional studies with a structured preoperative teaching program addressing such variables are so limited. Teaching elderly patients the appropriate modification of activities and effective use of anxiety-reduction techniques all impact favorably upon their recovery outcome. Thus, the focus of this study is to evaluate the impact of laparoscopic surgery and anesthesia-related educational program on preoperative-associated anxiety and postoperative quality of anesthesia recovery for elderly patients subjected to laparoscopic abdominal surgeries. Methodology: A randomized pretest-posttest and follow-up control group research design was utilized, in two specialized laparoscopic abdominal surgical departments affiliated to Alexandria Main University Hospital, between the first of January to the end of August 2020. We interviewed 86 elderly patients scheduled for elective laparoscopic abdominal surgeries divided randomly into control and intervention groups, for investigating the following study variables: (1) preoperative anxiety (using State Trait Anxiety Inventory on primary admission and the 2nd day of admission just before surgery), and (2) postoperative quality of anesthesia recovery (using Quality of Recovery Score-15 in the initial 24-hours post-surgery, before discharge, and on the 7th day follow-up schedule). The proposed Arabic-version instructional program was introduced to the intervention group, then a comparison of the means between the predetermined groups was performed. Results: Degree of anxiety for the intervention group following the instruction scheme proved to be significantly lowered than those in routine hospital care group. The program conduction confirmed to have a statistically significant effect on the intervention group’s recovery outcome than those in the parallel group including an amelioration in pain, physical discomfort, physical independence, as well as emotional dimensions, as evidenced by the marked percent improvement through the whole application periods. Conclusion: Preoperative engagement in the interventional informative sessions offers benefits to diminish the level of anxiety through gained knowledge and application of anxiety-relief manipulations in the subjected group. Through practiced skills of discharge self-management, quality of anesthesia recovery proved to be better than those in the control group with a statistically significant discrepancy between them. Recommendations: The pursuit of anxiety and recovery evaluation and management to be established as a routine screening and interventional measures for all elderly patients scheduled electively for laparoscopic surgery to ensure best geriatric patients’ outcomes. On top of that, developing of interventional informative sessions with reference to laparoscopic surgery, anesthesia, preparation for surgery, emotional support, and postoperative discharge management should be launched and stepped by all gerontological nurses in the perioperative stage.