Maandag 27 februari 2023
The role of preoperative anxiety in the development of postoperative delirium in older surgical patients (PhD study of Kelu Yang)
Postoperative delirium (POD) is an adverse complication that manifests as acute and fluctuating alterations of mental status, involving disturbances in attention, consciousness, and cognition. Among older patients undergoing cardiac and major noncardiac surgery, the incidence of POD is reported to be as high as 60%. POD leads to multiple adverse outcomes, including an excess in morbidity and mortality, an increase in the duration of hospitalization, higher rates of readmission, and functional decline, increased levels of dependency in activities of daily living post-discharge, and very high resources use. Therefore, the prevention of POD is essential.
The occurrence of POD has been proven to be associated with the interaction of multiple predisposing and precipitating factors, among which psychosocial factors have become increasingly important. Preoperative anxiety was suggested to be a possible precipitating factor, but few studies have focused on it. It was reported that 11-85% of patients admitted for surgery experience preoperative anxiety, which may cause hemodynamic change during anesthetic induction as well as increase the requirement of anesthetics intraoperatively, leading to an increased risk of postoperative complications. Although the pathophysiology of the relationship between preoperative anxiety and POD remains elusive, there are some potential mechanisms. Recent studies suggest that the migration of peripheral inflammatory cytokines into the central nervous system and the interaction of cytokines with microglia may induce neuroinflammation and subsequently delirium, and this pathway has also been implicated in anxiety.
There are abundant protocols to reduce anxiety that have been administrated before surgery including pharmacological therapy and non-pharmacological therapy. Unfortunately, anxiolytic premedication, especially benzodiazepines, has been proven to be significantly associated with POD despite being a common way of anxiety reduction. Non-pharmacological therapy has shown its therapeutic potential for preoperative anxiety and safety compared to pharmacologic therapy, such as cognitive-behavioral therapy, music therapy, preoperative patient education, massage, etc. However, whether the anxiety reduction of these kind of preoperative interventions also might reduce the risk of POD and more specifically, if there is a true relationship between preoperative anxiety and POD still needs to be elaborated.
As such, the aim of this project is to explore the role of preoperative anxiety in the development of POD in older surgical patients.
There are two parts in this project. The first part is to specify the conceptual issues of preoperative anxiety and POD. Systematic reviews will be conducted with regard to the in-depth insights in the clinical management of POD, and the relationship between preoperative anxiety and POD in older surgical patients. Besides, a Delphi study will be conducted to address the concept and assessment of preoperative anxiety in older patients. The second part is to develop, finetune and evaluate a non-pharmacological intervention to reduce preoperative anxiety and the incidence of POD in older surgical patients. Simultaneously, the relationship between preoperative anxiety and POD can be verified in this intervention study.
This project is part of the PhD of Kelu Yang. Her promotors are Prof. Koen Milisen, and Dr. Elke Detroyer from ACCENTVV - KU Leuven, and Prof. Steffen Rex from UZ Leuven.
