Preoperative psychological distress and acute postoperative pain among abdominal surgery patients

Abstract

Objective

To analyze preoperative psychological distress symptoms and their association with acute postoperative pain in patients undergoing abdominal surgery.

Method

Prospective observational study conducted at a University Hospital in Minas Gerais, Brazil. The sample included 118 patients in the hospital's elective abdominal surgery program. Psychological distress symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Pain levels were measured using the numeric verbal scale (NVS, 0–10 points) from admission to discharge from the post-anesthesia care unit. Descriptive statistics and an ordinal regression model were utilized to detect related factors, with a threshold for significance established at p < 0.05. Pain levels at discharge from the post-anesthesia care unit was considered the outcome variable.

Findings

Preoperatively, 50.8 % exhibited symptoms of anxiety (HADS-A ≥ 8) and 16.1 % exhibited symptoms of depression (HADS-D ≥ 8), with 14.4 % presenting both symptoms. The prevalence of pain (NVS >0) in the post-anesthesia care unit was 40.3 %. At admission, 5.8 % of patients reported moderate to severe pain (NVS ≥ 4), increasing to 29.7 % at 60 min and 22.1 % at discharge. Regression analysis showed that anxiety or depression (OR = 4.49, p < 0.01) significantly increased the likelihood of experiencing higher pain levels, which was even greater when both symptoms coexisted (OR = 10.19, p < 0.01). Additionally, older age (OR = 0.94, p < 0.01) and inadequate pain management (OR = 7.67, p < 0.01) were significant predictors of pain levels at discharge.

Conclusion

Preoperative psychological distress, particularly the simultaneous presence of anxiety and depressive symptoms, significantly elevates the likelihood of heightened pain intensity in patients undergoing abdominal surgery.