Key result
Preoperative anxiety linked to a ~11% incidence of perioperative stroke, MI, or death.
Why the study?
Psychological factors like anxiety and depression may influence outcomes after vascular surgery procedures, but their association with postoperative outcome following elective carotid surgery remained to be investigated.
Does preoperative anxiety predict the composite of stroke, myocardial infarction, and death in asymptomatic patients undergoing elective carotid endarterectomy?
Observational (n=98)
Outcome assessors blinded
No
Does preoperative anxiety predict the composite of stroke, myocardial infarction, and death in asymptomatic patients undergoing elective carotid endarterectomy?
Preoperative anxiety (HADS-A > 6) is associated with an increased risk of perioperative neurological events in asymptomatic patients undergoing elective carotid endarterectomy.
Answers are grounded in this paper and cite their sources.
May warrant anxiety screening before elective CEA; hypothesis-generating and requires prospective validation.
BACKGROUND: Psychological factors like anxiety and depression are recognised to play a causal role in the development of cardiovascular disease and they may also influence outcome after vascular surgery procedures. The aim of this study was to investigate the association of anxiety and depression with postoperative outcome following elective carotid surgery. METHODS: Single centre prospective observational study of patients treated for asymptomatic carotid artery stenosis at an academic vascular surgery centre. Preoperative anxiety and depression were evaluated using self-reporting questionnaires: Spielberger State-Trait Anxiety Inventory (STAI-S/-T) and Hospital Anxiety and Depression Scale (HADS-A/-D). Postoperative morbidity and mortality were assessed with the primary composite endpoint of stroke, myocardial infarction (MI) and death. Standard reporting guidelines for carotid disease were applied. RESULTS: From June 2012 to November 2015, 393 carotid endarterectomies (CEA) were performed at our institution. Out of those, 98 asymptomatic patients were available for analysis (78% male; median age, 71.1 years). Median scores of self-reporting questionnaires did not differ from published data of the general population (STAI-T, trait component, median, 36; IQR, 31-42.75; STAI-S, state component, median, 38; IQR, 32-43; HADS-A median, 6; IQR, 3-8; HADS-D median, 4; IQR, 2-7). Cardiovascular risk factors were similar in anxious and non-anxious patients. The composite endpoint of stroke, MI and death occurred significantly more often in patients presenting with a preoperative HADS-A score higher than 6 (10.5%, 95% CI, 3-25; p =.020). CONCLUSIONS: The present study indicates that preoperative anxiety is associated with the occurrence of intra- and postoperative neurological events in patients undergoing CEA. Patients who had a preoperative HADS-A score of 6 or less had a very low probability of experiencing these complications.
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Aspalter et al. (2021) conducted an observational in Asymptomatic carotid artery stenosis (n=98). Preoperative anxiety (HADS-A score > 6) vs. No preoperative anxiety (HADS-A score ≤ 6) was evaluated on Composite of stroke, myocardial infarction (MI), and death (30-day mortality) (p=0.020). Preoperative anxiety (HADS-A score > 6) was associated with a higher incidence of perioperative stroke, myocardial infarction, or death compared to lower anxiety scores.
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