International Journal of Surgery 12 (2014) 1473e1477

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Original research

Overestimation of mortality risk and preoperative anxiety in patients undergoing elective general surgery procedures: A propensity matched analysis Gildasio S. De Oliveira Jr. a, *, Jane L. Holl b, Robert J. McCarthy a, Zeeshan A. Butt c, Jacob Nouriel a, Kirsten McCaffery d, Michael S. Wolf e a

Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, United States Center for Health Care Studies, Feinberg School of Medicine, Northwestern University, United States Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States d Faculty of Medicine, The University of Sydney, Australia e Department of Medicine, Feinberg School of Medicine, Northwestern University, United States b c

h i g h l i g h t s  This is the first study to objectively measure patient overestimation of surgical risk and link that with important surgical outcomes.  Overestimation of surgical risk was associated with delayed of surgical procedures.  This study calls for a better system to assure optimal patient knowledge about surgical risks.

a r t i c l e i n f o

a b s t r a c t

Article history: Received 10 September 2014 Received in revised form 3 November 2014 Accepted 12 November 2014 Available online 18 November 2014

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 (2.7e32.9). 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. © 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.

Keywords: Surgical risk Overestimation Anxiety

1. Introduction

* Corresponding author. Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, 241 East Huron St, F5-704, Chicago, IL, United States. E-mail address: [email protected] (G.S. De Oliveira). http://dx.doi.org/10.1016/j.ijsu.2014.11.016 1743-9191/© 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.

Preoperative anxiety is a common and undesirable outcome in the care of surgical patients [1e3]. Several studies have demonstrated that greater levels of preoperative anxiety are associated with worse acute postoperative pain and even with the

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development of chronic post-surgical pain [4e7]. In addition, preoperative anxiety has been associated with greater length of hospitalization stay and increased hospital readmissions after surgery [8,9]. Recently, preoperative anxiety has also been demonstrated to be an independent predictor of major morbidity and mortality after cardiac surgery [10]. Deficiencies in risk communication have been demonstrated in the surgery field that can significantly jeopardize the informed consent process and alter decisions of surgical patients [11]. Misleading risk assessments is a common factor leading to the development of clinical anxiety in non-surgical settings when humans face new environments or challenging tasks [12]. Recognition and correction of misleading risk assessments may be a strategy to minimize the development of clinical anxiety in surgical patients. Conversely, it remains to be determined if misleading surgical risk perception is associated with the development of preoperative anxiety in general surgery patients. The main objective of the current investigation was to evaluate a possible association between overestimation of surgical mortality risk and the development of preoperative anxiety in general surgery patients. We hypothesized that patients who overestimated surgical risks had a greater prevalence of preoperative anxiety. In addition, we also sought to evaluate if overestimation of surgical risk was associated with voluntary delays of procedures by general surgery patients.

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Overestimation of mortality risk and preoperative anxiety in patients undergoing elective general surgery procedures: a propensity matched analysis.

Deficiencies in risk communication have been identified in perioperative medicine. Objective measurement of risk overestimation by general surgery pat...
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