Fear Of Surgery Research Articles

Caesarean section vs vaginal birth: a narrative review of decision making and postnatal outcomes

Background/Aims Few studies have mapped decision-making factors behind mode of birth to postpartum outcomes. This review's aim was to compare factors that drive women's decision making on mode of birth and postnatal outcomes. Methods This narrative literature review of Google Scholar, PubMed, Medline and Wiley Online Library explored studies published from 2000 onwards that compared caesarean section and vaginal birth in relation to decision-making factors and postnatal quality of life. Extracted data were analysed thematically. Results A total of 10 articles were included. Most women favoured vaginal birth, associating it with satisfaction, fear of surgery and cultural norms. Caesarean sections were favoured because of a fear of pain, previous caesarean section experience and the perception that it was easier. There were poorer physical and mental postpartum quality of life outcomes for caesarean sections and assisted vaginal birth, even after 10 years. Conclusions Healthcare professionals require more exposure to supporting women to decide on mode of birth. Routine checks for new mothers require a holistic, person-centred approach as opposed to generalised care. Implications for practice Healthcare workers can and should make every contact with intending and present mothers count. Open conversations about childbirth need to be had, even outside of women's health spaces, with appropriate referrals and signposting to best available evidence for informed decisions to be made regarding mode of childbirth and expected outcomes.

Single-cell sequencing decodes the secrets of the RAP phenomenon of corticotomy.

Corticotomy-assisted tooth movement is commonly performed in clinics, however, its time-limited efficacy and the fear of surgery among patients significantly limit its clinical application. Hence, researchers have investigated non-invasive methods to accelerate tooth movement. However, the molecular mechanisms underlying corticotomy-assisted tooth movement are not fully understood. Micro-CT and TRAP stain were used to tooth movement and bone resorption. Single-cell RNA sequencing was used to study the transcriptome heterogeneity of macrophages after corticotomy. Transmission electron microscopy and iron ion detection was used to evaluate ferroptosis and iron metabolism. In addition, we carried out immunohistochemistry, quantitative real-time and flow cytometry verify the effect of iron on macrophage polarization. Single-cell RNA sequencing of digested alveolar bone identified a significant increase in iron metabolism-related genes post-corticotomy. Macrophages play a central role in this field. Following the dimensionality reduction of macrophages, we revealed a new developmental state via pseudotime analysis post-corticotomy. SCENIC analysis revealed that Atf3 is a key transcription factor influencing this new state. We found that Atf3+ macrophages were closely associated with osteoclasts. Moreover, cell chat revealed an increase in cellular communication between Atf3+ macrophages and other cell types after corticotomy. These findings suggested that Atf3+ macrophages might play a key role in corticotomy-accelerated tooth movement, thus providing potential targets for drug development.

Role of Home Remedies and Self-Medication in Late Presentation of Acute Appendicitis and Its Possible Consequences

Acute appendicitis is a common surgical emergency with significant morbidity and mortality if not promptly diagnosed and treated. Delayed presentation is often attributed to factors like home remedies, self-medication, and misdiagnosis by non-medical professionals. This study aimed to identify the reasons for delayed presentation of acute appendicitis in patients presenting to Northwest General Hospital, Peshawar. This retrospective study was conducted from January 2021 to October 2022, including 120 patients with acute appendicitis. Most patients (61%) were male, with an average age of 45 years. A significant number of patients (48%) presented from remote areas, and 31% delayed seeking medical attention for more than 2 weeks. Common reasons for delay included self-medication (38%), misdiagnosis by non-medical professionals (57%), and fear of surgery. Delayed presentation of acute appendicitis is a significant public health issue in the study area. Factors contributing to delay include limited access to healthcare, self-medication, and misdiagnosis. Early diagnosis and prompt surgical intervention are crucial to reduce complications and improve outcomes. Raising awareness among the public and healthcare providers about the importance of early presentation for acute appendicitis is essential.

Incidence, Associated Factors, and Behavioral Consequences of Intraoperative Awareness and Dreams During General Anesthesia Among Adult Patients: A Prospective Cohort Study.

Background The intraoperative awareness with recall phenomenon involves the memory of intraoperative events. The reported incidence is 0.001%. Awareness is rare intraoperatively but has profound implications. This research aimed to study intraoperative awareness and dream experiences in the Omani population undergoing general anesthesia. Methods This prospective cohort study involving 300 adult patients was conducted at a tertiary-level hospital between July and December 2021. Awareness was assessed in the post-anesthesia care unit and then at home on the seventh day and one month telephonically using a modified Brice questionnaire. The study's primary outcome was the incidence of IOA and dreams in adult Omani patients undergoing GA. The secondary outcome was identifying the factors associated with intraoperative awareness and dreams under GA. Results In this study, the incidence of awareness was 0.3%while 7.6% of patients reported intraoperative dreams. The patient who experienced IOA underwent an endoscopic retrograde cholangiopancreatography under GA with neuromuscular blockade and had a prolonged recovery. A total of 49.33% developed psychological effects postoperatively; anxiety, irritability, fear of surgery, change in memory, and repetitive nightmares were the most common ones. Because of the limited sample size, no factor associated significantly with these outcomes was found. Conclusion This study observed a higher incidence of intraoperative awareness and dreams. Awareness might be due to prolonged recovery and the use of neuromuscular blocking agents, but a focused study is required to confirm this finding. The incidence of intraoperative dreams and postoperative psychological effects of GA was also high. It may be worth exploring these findings with larger population-based research.

FEAR OF SUDDEN DEATH ‘INTERRUPTED‘ BY WEARABLE DEFIBRILLATOR: CASE REPORT

Abstract A male patient (pt) 49y,grade II familiarity for sudden cardiac death (SCD).He arrived in the emergency department for worsening dyspnea and he underwent ECG:sinus rhythm and left bundle branch block(QRS duration 170 msec);color Doppler echocardiogram (CDE)showing:Dilated left ventricle, severely and globally hypocontractile(EF30%).Negative cardiac enzymes on laboratory tests.The coronary arteries were normal at angiographic control.The pt did not undergo to cardiac MRI because of claustrophobia.Blood samples were sent for genetic screening for cardiomyopathy.The pt started drug therapy following ESC guidelines.He was transferred to cardiopulmonary rehabilitation department.At the end of the 2 weeks of the rehabilitation cycle, left ventricular systolic dysfunction persisted.The pt was discharged with a wearable defibrillator (WCD) to continue therapy optimization following ESC heart failure guidelines.At the end of 3 months,the pt underwent an echocardiographic recheck which confirmed dilated,severely,and globally hypocontractile left ventricle(EF35%).ICD implantation was indicated, but the pt refused it.Therefore,was prescribed the continuation of SCD protection by WCD.The pt underwent monthly followups,for the next 6 months,reporting no improvement in left ventricular contractile capacity measured by CDE and continuing to refuse biventricular ICD implantation.We noted a correct and consistent wearing of the WCD.After 177 days of wearing,the pt had an episode of loss of consciousness and WCD shock.A remote device check documented ventricular fibrillation at 200 bpm,which was correctly recognized and discontinued.The pt accepted biventricular ICD implantation.At follow–up at 1 month CDE documented improvement in left ventricular contractile capacity(EF 40%),and no arrhythmic events in the absence of symptoms.WCDs have been used extensively in Italy since 2015.This technology provides temporary protection from SCD for pts with an evolving risk profile who are not yet eligible for an ICD.WCD is an effective therapy for the treatment of SCD with a very low complication rate and high pt compliance over time.Our case demonstrates how WCD enabled optimal titration of drug therapy following guidelines and prevented sudden death in young high–risk pts.In addition, our case shows that reduced compliance for definitive ICD implantation due to non–acceptance of the disease,fear of surgery,or subsequent lifestyle changes are not barriers to saving patients from SCD.

The Relationship Between Cognitive Intrusion of Pain, Fear of Surgery, and Comfort

The aim of this study was to examine the relationship between cognitive intrusion of pain, fear of surgery, and comfort in the perioperative period. This was a descriptive study conducted with 180 patients hospitalized for surgery in a training and research hospital. A sociodemographic questionnaire, Surgical Fear Questionnaire, General Comfort Questionnaire, and Experience of Cognitive Intrusion of Pain Scale were administered to the participants prior to surgery, while General Comfort Questionnaire and Experience of Cognitive Intrusion of Pain Scale were administered after surgery. Of the participants with a mean age of 49.94 ± 17.26 years, 62.2% were male and 31.1% had at least one chronic disease. The mean preoperative and postoperative pain scores were 2.65 and 3.47, respectively. There was a statistically significant negative correlation between perioperative experience of cognitive intrusion of pain and perioperative comfort and a positive correlation between perioperative experience of cognitive intrusion of pain and preoperative fear of surgery (p < .05). Cognitive intrusion of pain does not change in the perioperative period. As the cognitive intrusion of pain increases, patient comfort decreases and surgical fear increases. Our study contributes to the literature since it is the first study evaluating the cognitive intrusion of pain in the perioperative period.

P230: The challenges of implementing early surgery for terminal ileal Crohn’s disease – a qualitative study of the clinician perspective

Abstract Background Recent evidence suggests that “early” bowel resection may offer more stable remission in terminal ileal (TI) Crohn’s disease compared to medical therapy. Surgery is still often considered late in the treatment pathway. The aims of this study were to understand how clinicians make decisions about treatment for TI Crohn's and to explore their views on the role of surgery. Methods Semi-structured interviews with clinicians across the UK, with an interest in inflammatory bowel disease (IBD), were undertaken using videoconferencing (February to November 2022). Inductive thematic analysis was performed and 10% of the data were double-coded. Data saturation was confirmed before stopping recruitment. Results Participants included 9 consultant surgeons, 7 consultant gastroenterologists and 7 specialist nurses (n=23) from secondary care and tertiary referral centres. Five key themes were identified: approach to management and decision-making, opinions on medical therapy, opinions on surgery, approach to information-giving, and patients’ preferences from a clinician perspective. Symptoms, disease phenotype, patient choice and the influence of the IBD multidisciplinary team were frequently discussed factors that guide management. Trial of multiple drugs before offering surgery was commonly described. A lack of IBD surgeons and long waiting lists for surgical clinics and theatre were cited as barriers to timely surgery. Patients' fear of surgery was thought to be driven by the risk of a stoma. Conclusion This study highlights key barriers to early surgery for TI disease. Early discussion of surgery may allow patients to make an informed choice. Organisational barriers should be considered when designing local services.

Patient delay in initiating treatment after breast cancer diagnosis: A cause for concern

Objectives Delayed presentation, diagnosis, and treatment negatively impact the survival of breast cancer patients. This study aimed to describe the time to initiation of treatment after breast cancer diagnosis and causes of delay to help identify targets for future interventions. Material and Methods A prospective study was carried out on breast cancer patients who had delay initiating two major oncologic treatments (chemotherapy and mastectomy) between July 2018 and June 2021. Data were analyzed by SPSS version 23.0. Results Sixty-two of 146 patients (42.5%) delayed initiating oncologic treatments. All patients were females, and their ages ranged from 21 to 70 years, with a median age of 48 years (mean 46.9 ± 10.3 years). Median durations of symptoms at presentation and between diagnosis and commencement of treatments were 6 and 10 months, respectively. The mean lump size at presentation and before treatment were 8.2 cm and 15.4 cm, respectively. Early versus advanced breast cancer was 21 (33.8%) vs. 41 (66.1%) at presentation and 2 (3.2%) vs. 60 (96.8%) before treatment. Major reasons for delayed treatment include the use of alternative therapy (48.4%), financial problems (24.2%), fear of surgery (9.7%), chemotherapy side effects (8.1%), and family interference (4.8%). The length of delay was not affected by the patient’s age, marital status, or level of education (p &gt; 0.05). Conclusion Patients had longer delays in initiating treatments after breast cancer diagnosis. Focusing on causes of secondary patient delay is equally as important as early detection and diagnosis.

“Problems you can live with” versus emergencies: how community members in rural Ethiopia contend with conditions requiring surgery

Background98% of people with surgical conditions living in low- and middle-income countries (LMICs) do not receive safe, timely and affordable surgical and anesthesia care. Research exploring barriers to receiving care has tended to be narrow in focus, often facility-based and ignoring the community beliefs, experiences and behaviours that will be an essential component of closing the gap in surgical care. Using qualitative methods, we captured diverse community perspectives in rural Ethiopia: exploring beliefs, perceptions, knowledge and experiences related to surgical conditions, with the overall aim of (re)constructing explanatory models.MethodsOur study was nested within a community-based survey of surgical conditions conducted in the Butajira Health and Demographic Surveillance Site, southern Ethiopia, and a follow-up study of people accessing surgical care in two local hospitals. We carried out 24 semi-structured interviews. Participants were community members who needed but did/did not access surgical care, community-based healthcare workers and traditional bone-setters. Interviews were conducted in Amharic, audio-recorded, transcribed, and translated into English. We initially carried out thematic analysis and we recognized that emerging themes were aligned with Kleinman’s explanatory models framework and decided to use this to guide the final stages of analysis.ResultsWe found that community members primarily understood surgical conditions according to severity. We identified two categories: conditions you could live with and those which required urgent care, with the latter indicating a clear and direct path to surgical care whilst the former was associated with a longer, more complex and experimental pattern of help-seeking. Fear of surgery and poverty disrupted help-seeking, whilst community narratives based on individual experiences fed into the body of knowledge people used to inform decisions about care.ConclusionsWe found explanatory models to be flexible, responsive to new evidence about what might work best in the context of limited community resources. Our findings have important implications for future research and policy, suggesting that community-level barriers have the potential to be responsive to carefully designed interventions which take account of local knowledge and beliefs.

An Analysis of Patients' Knowledge and Experience Associated with Metallic Dental Implant Material

Background: Metallic dental implant materials play a pivotal role in modern dentistry, serving as a key component in the restoration of missing teeth. Patients' knowledge and experiences related to these metallic materials are essential aspects in understanding the overall success and acceptability of dental implant procedures. Objective: To determine the patients' knowledge and experience (satisfaction and problems) associated with Metallic Dental Implant Material. Study Design: Cross-sectional survey-based study. Settings: Bhittai Dental Hospital Mirpur Khas and Hamdard University, Dental Hospital, Karachi Pakistan. Duration: Six months from march 2021 to August 2021. Methods: All the patients above 18 years of age, both gender, individuals who have previously undergone dental implant procedures involving metallic materials, those who are considering dental implant procedures with metallic materials were included. Data was collected using a structured questionnaire consisting of closed-ended questions regarding patients' knowledge and experience associated with metallic dental implant material. Data analysis was done by using SPSS version 26. Results: A total of 89 individuals were interviewed; out of them 55.15 were females and 44.9% were males. Most of the cases had heard about dental implant by medicos, random people and relatives. 37.1% patients had financial issues regarding dental implants, 25.8% had pain/discomfort after having an implant, 31.5% cases were facing to infection, 67.4% cases had limitation regarding meals after having a dental implant. Out of all 57.3% individuals were satisfied regarding their dental implants. Conclusion: Patients' knowledge and experience associated with metallic dental implant material observed to be average. Financial, fear of surgery, discomfort and infection issues were a major concern for a significant proportion of patients, indicating that cost may be a barrier to receiving dental implants for some patients. Despite these challenges, the majority of patients expressed satisfaction with their dental implants, indicating that the benefits of the procedure may outweigh the challenges.

Factors influencing surgical choice and anxiety in patients with pulmonary nodules smaller than 8 mm.

The detection of pulmonary nodules significantly impacts the lives and mental health of patients. Although the 2020 National Comprehensive Cancer Network (NCCN) guidelines recommend scheduled surveillance for nodules ≤8 mm, patients often opt to have their nodules surgically removed. A cross-sectional questionnaire was administered to patients with small pulmonary nodules who presented to a local grade 3 hospital with small pulmonary nodules and decided to receive surgery versus prescribed monitoring. The questionnaire included four aspects: (I) patient characteristics; (II) nodule-specific knowledge; (III) doctor-patient communication; and (IV) nodular-specific distress. Nodular-specific distress was measured by the Impact of Event Scale-Revised (IES-R). A total of 234 (69%) patients responded to the survey and were included in the final analysis. Poor performance in activities of daily living (ADLs), the presence of solid nodules, multifocal disease, and a family history of lung cancer were significantly associated with reported anxiety. Most notably, facilitating patient choice for surgery was the computed tomography (CT) scan results, with reference to lung nodule size and number of nodules, where concerns related to lung nodule, cancer risk, and fear of surgery or death had a significant psychological impact on patients. In this cohort of patients who elected to have their small pulmonary nodules surgically removed, we identified key factors underlying their anxiety toward guideline recommended surveillance. Our findings will be useful for clinicians when discussing treatment options with their patients.

The Effect of Preoperative Pain, Fear, and Anxiety on Postoperative Pain in Urological Surgery Patients: A Descriptive and Correlational Study

The study was conducted to determine the effect of preoperative pain, fear, and anxiety on postoperative pain and analgesia use in urology patients. A descriptive and correlational design was used. The population of the study consisted of patients who were hospitalized in the Urology clinic of a university hospital and were planning surgery. The sample consisted of 106 patients who met the inclusion criteria and agreed to participate in the study. The study's data was collected using the Personal Information Form, Analgesia Follow-up Form, Surgical Fear Questionnaire, Surgical Anxiety Questionnaire, and Visual Analog Scale prepared in line with the literature. Descriptive statistics, Pearson correlation coefficient, and linear regression analysis were used to evaluate the data. A positive linear relationship was found between postoperative pain and surgical anxiety, surgical fear, and preoperative pain (P<.05). Regression analysis revealed that preoperative pain (P=.006) affected the level of postoperative pain. In addition, fear of surgery (P=.035) and postoperative pain (P=.000) were found to affect the use of postoperative 24-hour analgesia. The study revealed a relationship between the postoperative pain experienced by the patients and preoperative pain, fear, and anxiety.

DENTAL IMPLANTS AS AN OPTION FOR MISSING TOOTH/TEETH REPLACEMENT: A STUDY ON PATIENT AWARENESS AND SOURCES OF INFORMATION

Objectives: This study was designed with an aim to assess the level of awareness regarding dental implant as a treatment modality for the replacement of missing teeth in the patients reporting to dental outpatient department and to determine their sources of information regarding implants. Methods: This was a questionnaire-based study to assess the awareness about dental implants and the related sources of information in 350 patients who reported to Department of Dentistry, Shyam Shah Medical College Rewa, Madhya Pradesh from 1st October 2022 to 31st December 2022. Results: Only 36.86% (n=129) of participants had heard of dental implants. Among these patients (N=129), only 30.23 % (n=39) received information about dental implants from dentists. Only 4 (3.10%) patients had themselves undergone treatment with dental implants. Awareness regarding implant composition was poor with only 6.98% (n=9) participants being aware that implants are made of titanium. Fear of surgery (33.33%) and high treatment cost (30.23%) were the most common limiting factors that governed the decision of patients regarding undergoing treatment with dental implants. Conclusion: The findings of the study indicate a low level of awareness about dental implants as a treatment option for replacing missing teeth. A very less number of participants received information from reliable sources. It is important to create awareness in general population regarding feasibility of implants for prosthetic rehabilitation and to make implant treatment easily accessible and affordable.

FRI525 Gender Differences In Fears Related To Low Risk Papillary Thyroid Cancer And Its Treatment

Abstract Disclosure: A.M. Sawka: None. S. Ghai: None. L. Rotstein: None. J.C. Irish: None. J.D. Pasternak: None. P.J. Gullane: None. E. Monteiro: None. J. Su: None. W. Xu: None. J.M. Jones: None. A. Gafni: None. N.N. Baxter: None. D.P. Goldstein: None. Background: It is important to understand the fears of individuals newly diagnosed with papillary thyroid cancer (PTC) to optimize patient counselling and supportive care. Our aim was to explore for potential gender differences in fears experienced by individuals with PTC prior to treatment. Methods: In this prospective study conducted in Toronto, Canada, we enrolled patients with untreated small low risk PTC (&amp;lt; 2 cm in maximal diameter), and offered them the choice of thyroidectomy or active surveillance (Clinicaltrials.gov: NCT03271892). All participants had a surgical consultation prior to assessment. Participants completed Fear of Progression (Short Form) and Fear of Surgery (referring to thyroidectomy) questionnaires, prior to making a decision on PTC management. We also evaluated potential fears that were specific to thyroidectomy (e.g. voice change, thyroid hormone treatment, hypocalcemia, and scar appearance). Total fear scores were calculated for the respective questionnaires. We compared data collected in women and men and explored for factors associated with respective fears using multivariable linear regression analyses. Results: We included 153 women of mean age 50.7 years (standard deviation, SD 15.0) and 47 men of mean age 56.3 years (SD 13.8). There were no significant differences in primary tumor size, marital status, education, parental status, or employment status of women and men. On a scale of 5 to 60 (where 60 is the worst), the mean total fear of disease progression questionnaire score was 26.2 (SD 9.7) in women and 23.0 (SD 9.2) in men (p=0.031). On a scale of 0 to 80 (80 being the worst), the mean total surgical fear questionnaire score was 34.1 (SD 20.3) in women and 22.0 (17.9) in men (p&amp;lt;0.001). Women were also more fearful than men about potential postoperative change in voice (p=0.001), hypocalcemia (p=0.003), and scar appearance (p&amp;lt;0.001). In respective multivariable linear regression analyses, age group (p&amp;lt;0.001) was independently inversely associated with fear of disease progression, whereas being a woman was independently associated with surgical fear (p=0.002). Conclusions: Demographic factors appear to be associated with fears of low-risk PTC patients who are considering primary disease management. Younger patients may have a greater fear of disease progression while women may have a greater fear of the morbidity from thyroidectomy. These factors may be important to consider in patient counselling. Presentation: Friday, June 16, 2023

Efficiency of Printed Patient Information Leaflets Written for Total Knee and Hip Arthroplasty Patients to Reduce Their Fear of Surgery.

Background: Patient education plays a key role in health care. In our study, we created a new information guide for patients waiting for total knee (TKA) or hip (THA) arthroplasty. The goal of our study was to create patient education material that would reduce patients' fear of surgery and improve their postoperative lifestyle. Methods: Patients in the intervention group (n = 44) received newly developed paper-based patient education material before surgery. The surgical fear questionnaire (SFQ) was used to assess fear reduction. A self-designed assessment questionnaire was used to measure the effectiveness of the leaflet among the intervention group patients. Results: The SFQ scores decreased significantly both in patients with TKA (median 37.50 IQR 30.00-40.00 vs. median 20.00 IQR 16.00-24.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 20.00 IQR 16.00-22.00). A control group with TKA (median 37.50 IQR 30.00-40.00 vs. median 64.50 IQR 54.00-82.00) and THA (median 34.50 IQR 28.00-42.00 vs. median 73.00 IQR 56.00-81.00) was also included. An assessment of the content, usability, and clarity of the new leaflet showed that patients rated the new leaflet as almost entirely usable (median score 12.00-10.00). Conclusions: Our results suggest that new printed patient education material may reduce the fear of surgery.

Patients' and Healthcare Professionals' Perspectives on Preoperative Informed Consent Procedure Obstacles and Potential Solutions, 2021: A Qualitative Study.

Informed consent discussions are individualized not only with regard to the patients' surgical condition and goals but also with their varying information needs, health literacy, and anxiety. Information is lacking regarding the views of patients and concerned healthcare professionals on the informed consent process. This study is aimed to explore patients' and healthcare professionals' perceived barriers during informed consent process and identify suggested solutions for improvement. Patients who underwent elective surgery, anesthetists, and surgeons were the subjects of a qualitative study employing focused group discussions and in-depth interviews. The study participants were chosen through the use of purposeful sampling. The main barriers identified by the patients include: inadequate explanation about the intended procedure, family's influence in the decision-making, fear of surgery, fear of light/power interruption, inadequate time for discussion, and not letting the family members attend the discussion. On the other hand, healthcare professionals also identified various barriers, which includes: inability of patients to understand the information, limited time to discuss with patients in detail, poorly designed informed consent form, poor awareness of patients, fear of patient refusal for surgery if the risks and associated health problems are explained, lack of adequate investigation to confidently explain about the disease condition, use of medical jargons, poor documentation habit of professionals and lack of legal system regarding ethical dilemmas. Patients and healthcare professionals have identified avoidable barriers that need the attention of concerned health professionals, educators, and the healthcare delivery system.

Prevalence and factors associated with surgery anxiety in hospitalized patients: a point-prevalence study.

Preoperative anxiety is a challenging problem in the preoperative care of patients. Identifying risk factors helps nurses provide psychological support during the pre-operative visit so that stress can be reduced. This study aimed to determine the prevalence of surgical anxiety and related factors in hospitalized surgical patients. This research was designed as a point-prevalence study. The study was completed with 223 patients hospitalized in the surgical clinics of a tertiary hospital in Turkey. Surgical anxiety questionnaire (SAQ) and State-trait anxiety inventory (STAI) were used for the assessment of anxiety. Preoperative anxiety prevalence was 69.5% according to the SAQ and 49.3% according to STAI. Women, participants with no primary school education, those who were unemployed and had low income, those with no previous surgery, those living in fear of surgery, the participants who underwent major surgery and general anesthesia, and those who did not have knowledge about the surgical procedure and anesthesia had higher anxiety according to the two scales. A highly significant and positive correlation was found between total STAI and total SAQ. The importance of surgical anxiety for the health system, which affects two out of every three hospitalized patients, should not be underestimated. Therefore, national and global plans should be made to prevent and manage surgical anxiety.

Does surgery cause anxiety, stress and fear in geriatric patients?

Because of physiological changes in geriatric patients, their surgical process differs from that of young adults. In this regard, the perioperative period is an extremely risky time for geriatric patients. The present study examined preoperative fear, anxiety, and perceived stress levels as well as the factors affecting them in elderly patients prior to surgical intervention. This study adopted a cross-sectional descriptive design. The study sample consisted of geriatric patients (n = 407) scheduled for elective laparoscopic cholecystectomy in a research and training hospital in northeast Turkey. Data were collected by the researchers using the personal information form, Perceived Stress Scale (PSS-10), Surgical Fear Questionnaire (SFQ) and Anxiety Specific to Surgery Questionnaire (ASSQ). In the data analysis, descriptive statistics, the t-test in independent groups, one-way analysis of variance (ANOVA), correlation analysis and Bonferroni tests for post hoc analyses were used. On the PSS-10, the mean score was higher for the 75-and-older age group, single patients, patients with a disease requiring medication, and those who had previously undergone surgery (P < 0.05). On the ASSQ, the mean score was lower for patients aged 65-69, university graduates, patients without children, and those without a disease requiring medication (P < 0.05). On the SFQ, the mean score was higher for the 75-and-older age group, primary school graduates, and single patients (P < 0.05). It was determined that being single, having a chronic disability, and advancing age had an effect on the patients' surgery-specific anxiety, perceived stress, and fear of surgery. Long-standing chronic diseases can negatively affect both stress and anxiety levels of individuals.

P-415 Cryostorage of human ovarian tissue: Evaluating the storage and disposal pattern of a 22-year period with 2475 patients

Abstract Study question What are the characteristics of patients who did ovarian tissue cryopreservation? Summary answer Patients store their ovarian tissue in average 5 years, when storage is actively ended about 50% of the patients conceived without using the frozen tissue. What is known already In female fertility protection two major options for cryopreservation are available today: cryopreservation of oocytes and ovarian tissue cryopreservation (OTC). If cryopreservation of oocytes is not feasible, OTC remains the only option for individual fertility protection in women, adolescents and especially prepubertal girls. Study design, size, duration The relevant parameters of a single university center were revised and digitalized in the period from 2019 to 2021 and were analyzed in the time period between 2000 and 2021. Participants/materials, setting, methods 2475 patients with stored ovarian tissue were analyzed. Data extraction was done with MedITEX (CRITEX) and processed with SPSS (IBM). To assess the patient motivation of storage, patients were contacted by letter, e-mail and telephone calls. Main results and the role of chance On average, patients were aged 26.8 years, diagnosed with breast cancer (44.8%) and lymphoma (22.4%) in majority. In the active storage group (n = 1320) patients were storing for 5.4 years, patient age was 25 years at time of OTC and indications were breast cancer (37.6%) and lymphoma (26.7%). Analyzing the longtime storage group ≥10 years (n = 148), patient age was 23.8 years at time of OTC, storage duration was 12 years and indications were again mainly breast cancer (27%) and lymphoma (27.7%). When patients deceased (n = 133), patient age was 28.1 years, with a storage duration of 2.7 years and initially diagnosed with breast cancer (39.8%) and sarcoma (17.3%). When storage ended (n = 1155), patients stored for 4.2 years, mean age was 33 years. Analyzing the mode of storage end we observed that 2.5% had a transplantation on site, 10.3% transferred their tissue to another cryobank while 11.5% deceased. The majority of this group (75.7%) ended their storage due to pregnancy (49.1%), no desire to have children (25.9%), too expensive storage fees (8.9%), death (8.5%), recurrence of cancer (8.5%), no partner (4%) and fear of surgery in the future (3.1%). 6.7% regretted the end of storage retrospectively. Limitations, reasons for caution Live birth rate was not part of this paper as our main intention was to explore the storage characteristics. Few patients transferred a part of the samples for retransplantation while still storing tissue on site. The response rate of 28.8% limits the scope for interpretation regarding end of storage. Wider implications of the findings The pregnancy rate resulting from ovarian tissue that wasn't removed for OTC (49,1%) supports the approach of removing only 50% of one ovary. The long storage time and the fact that 6.7% regretted the end of storage, shows how important the OTC is, it should be covered by health insurances. Trial registration number not applicable

Harmful impact of treatment refusal in T3-4M0 endolaryngeal squamous cell carcinoma candidates for total laryngectomy: A STROBE analysis

PurposeTo evaluate the consequences of treatment refusal in total laryngectomy (TL) candidates with T3-4M0 endolaryngeal squamous cell carcinoma (SCC). Materials and methodsA retrospective observational study was conducted in an inception cohort of 576 isolated T3-4M0 endolaryngeal SCC candidates for TL consecutively managed between 1970 and 2019 in a French university teaching hospital. The main endpoint was survival time and cause of death in 2 groups. Group A, 4.5% of the cohort, consisted of 26 patients who declined any laryngeal treatment. Group B consisted of 550 patients who accepted TL. Accessory endpoints were causes of TL refusal and associated variables. The STROBE guideline was applied. The significance threshold was set at P<0.005. ResultsOne-and 3-year actuarial survival estimates increased significantly (P<0.0001) from 39% and 15% in group A, to 83% and 63% in group B, respectively. In group A, 92% of causes of death implicated index SCC progression, whereas in group B intercurrent disease, metachronous second primary, locoregional and/or metastatic SCC progression and postoperative complications accounted for 37%, 31%, 29%, and 2%, respectively. The actuarial survival estimates within group A increased significantly (P=0.0003) from 0% at 1-year in patients managed with isolated supportive care to 56% in patients managed with chemotherapy (reaching 0% at 5years). Reasons for TL refusal were fear of surgery, refusal of tracheostoma, loss of physiologic phonation, and certain comorbidities. Age and chronologic period correlated significantly with TL refusal. Median age decreased (P<0.001) from 69years in group A to 58 years in group B. Percentage TL refusal increased (P<0.0001) from 2% to 11% before and after start 1990, respectively. ConclusionThe current study determined loss of survival with refusal of any laryngeal treatment including TL, noted benefit of chemotherapy associated to supportive care, and discussed the possible contribution of immunotherapy.