title: Overestimation of mortality risk and preoperative anxiety in patients undergoing elective general surgery procedures: a propensity matched analysis.
abstract: BACKGROUND
  Deficiencies in risk communication have been identified in perioperative medicine. Objective measurement of risk overestimation by general surgery patients has not been performed. In addition, it is unknown if surgical risk overestimation is associated with the development of preoperative anxiety. The main objective of the current investigation was to examine the association between overestimation of surgical mortality risk and the development of preoperative anxiety.
  
  
  METHODS
  Patients estimation of surgical morality risk was compared to the actual mortality risk obtained by the American College of Surgeons national database. Preoperative anxiety was evaluated using a validated instrument. Propensity matched analysis was performed to examine an independent association between mortality risk overestimation and preoperative anxiety.
  
  
  RESULTS
  138 patients completed the study. 40 out of 138 (29%) patients overestimated their surgical mortality risk by at least 5%. 31 out of 138 (22%) patients estimated their surgical mortality risk by at least 10%. Patients who overestimated mortality risk (≥5%) were more likely to have postponed the surgery voluntarily, 9 out of 40 (23%) compared to patients who did not overestimate risk, 1 out of 98 (1%), P < 0.001. After propensity matching to control for covariate imbalances, overestimation of mortality risk was associated with the development of preoperative anxiety, OR (95%CI) of 9.5 (2.7-32.9).
  
  
  CONCLUSIONS
  Overestimation of perioperative mortality risk is common in patients undergoing general surgery and it is associated with preoperative anxiety and voluntarily delays of surgical treatment. Improved communication strategies are needed to minimize misleading risk perception in surgical patients.
authors.affiliation: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, United States. Electronic address: g-jr@northwestern.edu.
authors.forename: Gildasio S
authors.initials: GS
authors.lastname: De Oliveira
authors.affiliation: Center for Health Care Studies, Feinberg School of Medicine, Northwestern University, United States.
authors.forename: Jane L
authors.initials: JL
authors.lastname: Holl
authors.affiliation: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, United States.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McCarthy
authors.affiliation: Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States.
authors.forename: Zeeshan A
authors.initials: ZA
authors.lastname: Butt
authors.affiliation: Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, United States.
authors.forename: Jacob
authors.initials: J
authors.lastname: Nouriel
authors.affiliation: Faculty of Medicine, The University of Sydney, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
authors.affiliation: Department of Medicine, Feinberg School of Medicine, Northwestern University, United States.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D001007:Anxiety / Q000523:psychology*; D003142:Communication; D017558:Elective Surgical Procedures / Q000401:mortality* / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D018570:Risk Assessment; D012307:Risk Factors
keywords: Anxiety; Overestimation; Surgical risk