The role of pre-operative state-anxiety in the determination of intra-operative neuroendocrine responses and recovery.
OBJECTIVE
The psychophysiological model of adjustment to surgery predicts associations between (1) heightened pre-operative state-anxiety and intra-operative neuroendocrine responses, (2) neuroendocrine responses and complications; and (3) heightened pre-operative state-anxiety and post-operative recovery. The present study examined these associations.


METHODS
Participants were 39 patients (mean age 71.9+/-6.1 years) undergoing elective carotid endarterectomy surgery under local anaesthesia. In the week prior to surgery, patients completed baseline measures of physical and mental functioning using the MOS 36-item Short-Form Health Survey (SF-36). In addition to this, they undertook a 24-hour urine save to measure cortisol and catecholamines. Measures of state-anxiety were completed on the evening prior to surgery. A second 24-hour urine save was started at the time of anaesthetic induction. Follow-up measures of physical and mental functioning were completed 1 month following surgery. All complications were recorded during hospitalization.


RESULTS
There was a significant negative association between pre-operative state-anxiety and intra-operative cortisol (r=-.52, p<or=.001). Using hierarchical regression analysis, pre-operative state-anxiety accounted for 10% of the variance in intra-operative cortisol responses after controlling for medical and demographic factors. There were no significant associations between neuroendocrine responses and complications. Pre-operative state-anxiety was a significant determinant of poorer mental functioning following surgery, explaining 10% of the variance in scores after adjusting for baseline mental functioning.


CONCLUSIONS
Results from this study show increasing pre-operative anxiety to be associated with lower intra-operative cortisol responses and poorer mental functioning 1 month following surgery.
Pearson
Sue
S
Department of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia. Sue-Anne.Pearson@unisa.edu.au
Maddern
Guy J
GJ
Fitridge
Robert
R
D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology* / Q000652:urine; D001143:Arousal / Q000502:physiology*; D016894:Endarterectomy, Carotid / Q000523:psychology*; D004837:Epinephrine / Q000652:urine*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D006854:Hydrocortisone / Q000652:urine*; D007432:Intraoperative Period; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009638:Norepinephrine / Q000652:urine*; D011183:Postoperative Complications / Q000523:psychology* / Q000652:urine; D011300:Preoperative Care / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology; D012307:Risk Factors; D013223:Statistics as Topic; D013312:Stress, Physiological / Q000150:complications / Q000652:urine
D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine