Of 120 patients screened for eligibility and had finished followed-up on the day-0, pod-1, and pod-3. Of 4 patients refuse BAI scale assessment, and of 6 patients refuse CAM-CR scale assessment on the pod-7. The baseline demographics of study population were as follows (Table 1).
Table 1
Baseline Demographics of study population
Variable
|
|
Sex, male/female, n(%)
|
87(72.5%)/33(27.5%)
|
Age, yr, median (IQR)
|
69 (66 to 73)
|
Occupation, farmer/retiree/freelancer, n(%)
|
49(40.8%) /63(52.5%) /8(6.7%)
|
Types of cancer, gastric/ colon/rectal, n(%)
|
45(37.5%)/ 42(35.0%)/ 33(27.5%)
|
ASA physical status, I/II/III, n(%)
|
15(12.5%)/36(30.0%)/69(57.5%)
|
Methods of Anesthesia and analgesia, TAP /PCIA /TAP-PCIA / PCEA/ oral analgesics, n(%)
|
21(17.5%)/43(35.8%)/18(15.0%)/28(23.3%)/10(8.4%)
|
Surgical approaches, laparoscopy/ laparotomy, n(%)
|
95(79.2%)/25(20.8%)
|
Duration of anesthesia, min, median (IQR)
|
259 (196 to 357)
|
Duration of Surgery, min, median (IQR)
|
214 (151 to 308)
|
Duration in PACU, min, median (IQR)
|
87 (66 to 118)
|
Comparison of the BAI, VAS, and CAM-CR scores on the day-0, pod-1, pod-3, and pod-7. (Table 2 and Table 3)
Table 2
Comparison of the BAI, VAS, and CAM-CR scores during perioperative period
|
day-0
|
pod-1
|
pod-3
|
pod-7
|
BAI score
|
10 (8 to 12)
|
9 (8 to 10) *
|
8 (7 to 10) *
|
7 (4 to 8)*#↔
|
VAS score
|
0 (0 to 0)
|
3 (2 to 4)*
|
2 (2 to 3)*#
|
2 (1 to 2)*#↔
|
CAM-CR score
|
15 (14 to 16)
|
17 (16 to 20)*
|
17 (15 to 19)* #
|
16 (15 to 18)* #
|
Data are present as median (IQR)
* P versus day-0, # P versus pod-1, ↔ P versus pod-3
day-0 = one day before surgery, pod-1 = postoperative day 1, pod-3 = postoperative day 3, pod-7 = postoperative day 7
|
Table 3
Incidence of high anxiety, high pain, and delirium during perioperative period
|
day-0
|
pod-1
|
pod-3
|
pod-7
|
|
High anxiety, n(%)
|
23 (19.2%)
|
7 (5.8%)
|
11(9.2%)
|
0 (0.0%)
|
35*
|
High pain, n(%)
|
0(0.0%)
|
50 (41.7%)
|
18(15.0%)
|
5(4.2%)
|
57#
|
Delirium, n(%)
|
0(0.0%)
|
29(24.2%)
|
5 (4.2%)
|
0(0.0%)
|
31↔
|
day-0 = one day before surgery, pod-1 = postoperative day 1, pod-3 = postoperative day 3, pod-7 = postoperative day 7.
High anxiety = BAI score ≥ 16, high pain = VAS score༞3, diagnosed delirium = CAM-CR score༞22.
* 35 patients experienced high anxiety in the four days, of which 6 patients repeatedly experienced high anxiety.
# 57 patients experienced high pain in the four days, of which 16 patients repeatedly experienced high pain.
↔ 31 patients were diagnosed as delirium in in the four days, of which 3 patients repeatedly were diagnosed as delirium.
|
Table 4 Chi square test of cross table and spearman correlation analysis
|
Variable
|
preoperative high anxiety
|
postoperative high pain
|
postoperative delirium
|
|
P
|
r
|
P
|
r
|
P
|
r
|
Sex
|
0.542
|
0.079
|
0.481
|
-0.083
|
0.579
|
0.051
|
Age
|
0.021*
|
0.125
|
0.408
|
0.145
|
0.000**
|
0.566
|
Occupation
|
0.772
|
-0.027
|
0.534
|
0.091
|
0.038*
|
0.181
|
Types of cancer
|
0.000**
|
-0.367
|
0.004*
|
-0.260
|
0.183
|
-0.049
|
ASA physical status
|
0.131
|
0.115
|
0.320
|
0.136
|
0.183
|
0.020
|
Methods of Anesthesia and analgesia
|
0.005*
|
-0.139
|
0.000**
|
-0.120
|
0.295
|
-0.085
|
Surgical approaches
|
0.001*
|
0.324
|
0.149
|
0.152
|
1.000
|
0.015
|
Duration of anesthesia
|
----
|
----
|
0.390
|
0.271
|
0.591
|
0.183
|
Duration of Surgery
|
----
|
----
|
0.319
|
0.272
|
0.375
|
0.088
|
Duration in PACU
|
----
|
----
|
0.576
|
-0.057
|
0.194
|
0.099
|
Preoperative high anxiety
|
----
|
----
|
0.000**
|
0.410
|
0.005*
|
0.281
|
Postoperative high pain
|
----
|
----
|
----
|
----
|
0.017*
|
0.236
|
*P<0.05, **P<0.001, r = Correlation coefficient
|
Table 5 Multiple linear regression analysis of preoperative high anxiety, postoperative high pain, and postoperative delirium
|
Dependent variable
|
independent variable
|
B
|
Std error
|
Beta
|
t
|
P
|
VIF
|
R2
|
adjustd R2
|
F
|
Preoperative high anxiety
|
constant
|
-0.491
|
0.542
|
----
|
-0.906
|
0.367
|
----
|
0.181
|
0.152
|
6.333
|
age
|
0.010
|
0.007
|
0.118
|
1.387
|
0.168
|
1.017
|
types of cancer
|
-0.134
|
0.048
|
-0.272
|
-2.785
|
0.006*
|
1.337
|
methods of Anesthesia and analgesia
|
0.000
|
0.029
|
0.000
|
0.001
|
0.999
|
1.176
|
surgical approaches
|
0.214
|
0.091
|
0.221
|
2.339
|
0.021*
|
1.248
|
Postoperative high pain
|
constant
|
0.582
|
0.149
|
----
|
3.901
|
0.000
|
----
|
0.182
|
0.161
|
8.617
|
types of cancer
|
-0.065
|
0.060
|
-0.104
|
-1.090
|
0.278
|
1.297
|
Methods of Anesthesia and analgesia
|
-0.017
|
0.037
|
-0.042
|
-0.460
|
0.646
|
1.156
|
Preoperative high anxiety
|
0.465
|
0.114
|
0.366
|
4.060
|
0.000**
|
1.153
|
Postoperative delirium
|
constant
|
-3.279
|
0.474
|
----
|
-6.917
|
0.000
|
----
|
0.390
|
0.368
|
18.354
|
age
|
0.048
|
0.007
|
0.525
|
6.929
|
0.000**
|
1.082
|
occupation
|
0.055
|
0.054
|
0.077
|
10.27
|
0.307
|
1.066
|
preoperative high anxiety
|
0.234
|
0.090
|
0.209
|
2.604
|
0.010*
|
1.208
|
postoperative high pain
|
0.057
|
0.071
|
0.064
|
0.793
|
0.430
|
1.228
|
B = partial regression coefficient, Std error = standard error, Beta = standardized regression coefficient, t = Students t test; VIF = variance inflation factor, R2 = coefficient of determination, F = equality of variances. *P<0.05, **P<0.001
|
The BAI scores were significantly lower on pod-7 [7 (4 to 8)] than on day-0 [10 (8 to 13)], pod-1 [9 (8 to 10)], and pod-3 [8 (7 to 10)] (unadjusted P < 0.001, P < 0.001, P = 0.001, respectively; adjusted P < 0.001, P < 0.001, P = 0.005 ). The BAI scores were lower on pod-1 and pod-3 than on day-0. (unadjusted P = 0.004 and P < 0.001; adjusted P = 0.239 and P < 0.001 ). The BAI scores were lower on pod-1 than on pod-3 ((unadjusted P = 0.001, adjusted P = 0.006). (Table 2). The incidences of high anxiety (BAI score ≥ 16) occurred on day-0, pod-1, pod-3, and pod-7 were 19.2%, 5.8%, 9.2%, and 0.0%, respectively (Table 3).
The VAS scale shown that the patient's pain scores gradually decreased over time. The pain VAS scores were signifcantly higher on pod-1 [3 (2 to 4)], pod-3 [2 (2 to 3)], and pod-7 [2 (1 to 2)] than on day-0 [0 (0 to 0)] (unadjusted P < 0.001, P < 0.001, P < 0.001, respectively; adjusted P < 0.001, P < 0.001, P < 0.001, respectively ). The pain VAS scores were signifcantly higher on pod-1 than on pod-3 and pod-7 (unadjusted P = 0.001 and P < 0.001; adjusted P = 0.006 and P < 0.001). The pain VAS scores were signifcantly higher on pod-3 than on pod-7 (unadjusted P = 0.001; adjusted P = 0.004 ) (Table 2). The incidences of high pain (VAS score༞3) occurred on day-0, pod-1, pod-3, and pod-7 were 0.0%, 41.7%, 15.0%, and 4.2%, respectively (Table 3).
The CAM-CR scores were significantly higher on pod-1 [17 (16 to 20)], pod-3 [17 (15 to 19)], and pod-7 [16 (15 to 18)] than on day-0 [15 (14 to 16)] (unadjusted P < 0.001, P < 0.001, P < 0.001, respectively; adjusted P < 0.001, P < 0.001, P < 0.001, respectively). The CAM-CR scores were higher on pod-1 than on pod-3 and pod-7 (unadjusted P = 0.026 and P < 0.001; adjusted P = 0.157 and P < 0.001). The CAM-CR scores were significantly higher on pod-3 than pod-7 (unadjusted P = 0.002 and adjusted P = 0.014 ) (Table 2). The incidences of delirium (CAM-CR score༞22) occurred on day-0, pod-1, pod-3, and pod-7 were 0.0%, 24.2%, 4.2%, and 0.0%, respectively (Table 3).
Of 23 (19.2%) patients experienced preoperative high anxiety (BAI score ≥ 16). Of 57 (47.5%) patients experienced postoperative high pain (VAS score༞3). Of 31(25.8%) patients were diagnosed delirium (CAM-CR score༞22).
The correlation and influencing factors of preoperative high anxiety, postoperative high pain, and postoperative delirium and baseline data. (Table 4 and Table 5 )
The result of cross-table continuous corrected chi-square test and Pearson correlation analysis shown that preoperative high anxiety had a significant difference with age, types of cancer, methods of anesthesia and analgesia, and surgical approaches (P = 0.021, r = 0.125; P<0.001, r=-0.367; P = 0.005, r=-0.139; and P<0.001, r = 0.324, respectively) (Table 4). Through multiple linear regression analysis to analyze statistically significant variables (age, types of cancer, methods of anesthesia and analgesia, and surgical approaches) from chi-square test, types of cancer and surgical approaches were considered to be independent risk factors of preoperative high anxiety (P = 0.006 and P = 0.021) (Table 5).
Postoperative high pain had a significant difference with types of cancer, methods of anesthesia and analgesia, and preoperative high anxiety (P = 0.004, r=-0.260; P<0.001, r=-0.120; P<0.001, r = 0.410, respectively) (Table 4). Through multiple linear regression analysis to analyze statistically significant variables (types of cancer, methods of anesthesia and analgesia, and preoperative high anxiety) from chi-square test, preoperative high anxiety was considered to be an independent risk factor of postoperative high pain (P<0.001) (Table 5). It means that preoperative high anxiety had a significant positive impact on postoperative high pain.
Postoperative delirium had a significant difference with age, occupation, preoperative high anxiety and postoperative high pain (P<0.001, r = 0.566; P = 0.038, r = 0.181; P = 0.005, r = 0.281; P = 0.017, r = 0.236, respectively) (Table 4). Through multiple linear regression analysis to analyze statistically significant variables ( age, occupation, preoperative high anxiety and postoperative high pain) from chi-square test, age and preoperative high anxiety were considered to be independent risk factors of postoperative delirium (P<0.001 and P = 0.010). (Table 5).