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PubMed2026

Laparoscopic Surgery Is Associated With Reduced Small Bowel Obstruction Risk After Colorectal Cancer Surgery: A Nationwide Cohort Study of 5458 Patients.

INTRODUCTION: Postoperative small bowel obstruction (SBO) is a major complication following colorectal cancer surgery, yet evidence-based prevention strategies remain unclear. We aimed to clarify site-specific risk factors for SBO and evaluate the effectiveness of laparoscopic surgery and adhesion prevention materials (APMs) in preventing SBO after colorectal cancer surgery. METHODS: This retrospective cohort study analyzed 5458 patients who underwent colorectal cancer surgery at 32 Japanese institutions between 2012 and 2014. The primary endpoint was the 5-year risk of SBO. We evaluated the effects of laparoscopic surgery, APM use, and stoma creation on SBO risk. Clinical variables included demographics, tumor site, operative approach, operative details, and postoperative complications. Hospital-level clustering was addressed using mixed-effects logistic regression. RESULTS: Overall SBO incidence was 5.2% (n&#x2009;=&#x2009;283). Rectal cancer had the highest risk, whereas all colonic sites except the descending colon showed significantly lower odds. Laparoscopic surgery was associated with a 42% reduction in odds (OR 0.58; 95% CI 0.45-0.74; p&#x2009;<&#x2009;0.001), with significant reductions in ascending (NNT&#x2009;=&#x2009;22.2, p&#x2009;=&#x2009;0.001) and sigmoid colon surgery (NNT&#x2009;=&#x2009;30.2, p&#x2009;=&#x2009;0.003). APMs showed no protective effect (OR 1.01; 95% CI 0.78-1.32; p&#x2009;=&#x2009;0.94). Stoma creation significantly increased SBO risk (OR 1.84; 95% CI 1.35-2.51; p&#x2009;<&#x2009;0.001). Secondary analysis identified reoperation and postoperative ileus as additional independent risk factors. DISCUSSION: Laparoscopic surgery was associated with reduced long-term SBO risk, with significant benefits in ascending and sigmoid colon surgery. APMs showed no measurable benefit. Stoma creation increased SBO risk, with no observed difference between ileostomy and colostomy.

adhesion prevention material↗
PubMed1998

Carotid artery stenosis--where do we go from here?

Carotid artery stenosis is an important risk factor for stroke. The European Carotid Surgery Trial (ECST) and the North American Symptomatic Carotid Endarterectomy Trial (NASCET) have demonstrated that the risk of stroke is reduced by surgery in patients with high grade stenosis (70-99%). However, because the two trials used different methods to measure stenosis, the results are not comparable and the level of stenosis which is associated with increased risk of stroke cannot be strictly defined. The benefit of surgery in asymptomatic patients is more controversial. Some studies indicate that surgery reduces the risk of stroke only in patients with ?80% stenosis and others have shown benefits for patients with ?60% stenosis. Overall, the benefits of surgery in asymptomatic patients are more difficult to define. Carotid lesion morphology also plays an important role in determining the risk of stroke; plaques which are ulcerated and echolucent are associated with a higher risk of stroke. Arteriography has been long regarded as the gold standard diagnostic tool for carotid stenosis. It is a costly and invasive technique with potentially serious complications. The results of arteriography have not been standardised which makes comparison of results from different laboratories difficult. Duplex ultrasound is inexpensive, non-invasive and can provide functional and anatomical information about vessel stenosis and plaque morphology. The use of echo-enhancing agents helps to reduce operator variability, improves ultrasound images and can help to distinguish between pseudo and true occlusions, to identify patients who will benefit most from surgery. The echo-enhancing agent Levovist(R) is safe, produces consistent results and can enhance images throughout the blood pool. Clinical studies with Levovist(R) have shown it to be safe and highly effective in improving diagnostic confidence in patients with carotid artery stenosis. The number of non-diagnostic scans is reduced markedly when Levovist(R) is used to enhance ultrasound images.

Carotid Stenosis↗
PubMed2006

Prophylactic surgery to reduce the risk of gynecologic cancers in the Lynch syndrome.

BACKGROUND: Women with the Lynch syndrome (hereditary nonpolyposis colorectal cancer) have a 40 to 60 percent lifetime risk of endometrial cancer and a 10 to 12 percent lifetime risk of ovarian cancer. The benefit of prophylactic gynecologic surgery for women with this syndrome has been uncertain. We designed this study to determine the reduction in the risk of gynecologic cancers associated with prophylactic hysterectomy and bilateral salpingo-oophorectomy in women with the Lynch syndrome. METHODS: Three hundred fifteen women with documented germ-line mutations associated with the Lynch syndrome were identified. Women who had undergone prophylactic hysterectomy (61 women) and women who had undergone prophylactic bilateral salpingo-oophorectomy (47 women) were matched with mutation-positive women who had not undergone the procedure in question (210 women for the analysis of endometrial cancer and 223 for the analysis of ovarian cancer). Women who had undergone prophylactic surgery and their matched controls were followed from the date of the surgery until the occurrence of cancer or until the data were censored at the time of the last follow-up visit. RESULTS: There were no occurrences of endometrial, ovarian, or primary peritoneal cancer among the women who had undergone prophylactic surgery. Endometrial cancer was diagnosed in 69 women in the control group (33 percent), for an incidence density of 0.045 per woman-year, yielding a prevented fraction (the proportion of potential new cancers prevented) of 100 percent (95 percent confidence interval, 90 to 100 percent). Ovarian cancer was diagnosed in 12 women in the control group (5 percent), for an incidence density of 0.005 per woman-year, yielding a prevented fraction of 100 percent (95 percent confidence interval, -62 to 100 percent). CONCLUSIONS: These findings suggest that prophylactic hysterectomy with bilateral salpingo-oophorectomy is an effective strategy for preventing endometrial and ovarian cancer in women with the Lynch syndrome.

Adult↗
PubMed2006

A preoperative and intraoperative predictive model of prolonged intensive care unit stay for valvular surgery.

BACKGROUND AND AIM OF THE STUDY: In developing countries, the costs of intensive care unit (ICU) stay are very high for patients after valve surgery. In addition, patients with a prolonged ICU stay have a poor prognosis compared to those with a short ICU stay. The study aim was to develop a specific risk model and to use a logistic EuroSCORE model to predict prolonged ICU stay after valve surgery. METHODS: A total of 507 consecutive patients undergoing valve surgery were studied using univariate and multivariate analyses. Prolonged ICU stay was defined as five days or more. Stepwise logistic regression analysis was used to identify the risk factors for prolonged ICU stay. These variables were then used to calculate a prognostic score (S) and a predicted probability (P) for prolonged ICU stay. A receiver operating characteristic (ROC) curve was calculated to measure the prognostic value of the new risk model and logistic EuroSCORE model. Sensitivity and specificity analysis were used for evaluation. RESULTS: Multivariate logistic regression analysis showed that age > or = 65 years, left ventricular ejection fraction (LVEF) < or = 50%, cardiothoracic ratio (CTR) > or = 0.68, previous cardiac surgery, maximal voluntary ventilation (MVV) observed/predicted < 71% and repeat cardiopulmonary bypass (CPB) during surgery were risk factors. Mitral valve surgery reduced the risk of prolonged ICU stay. Observed probabilities compared well with predicted probabilities. The ROC curve produced an area under the curve (AUC) value of 0.81 for prolonged ICU stay. Based on predicted probability, patients were classified as low-risk (0 < or = P < 10%), intermediate-risk (10% < or = P < 20%), high-risk (20% < or = P < 40%) and very high-risk (> or = 40%) groups. A P-value > or = 40% was used as a cut-off point for the prognostic test. The specificity of this test was 97%, sensitivity 32%, positive predictive value 62%, negative predictive value 89%, positive likelihood ratio 10.67, and negative likelihood ratio 0.70. The ROC curve of a logistic EuroSCORE model gave an AUC value of 0.66 for prolonged ICU stay. CONCLUSION: The study results showed that individual patients undergoing valve surgery could be stratified according to their risk factors for prolonged ICU stay. High-risk patients may require more careful preoperative and postoperative management to reduce postoperative mortality, morbidity, the length of ICU stay, and therefore the cost of valve surgery.

Cardiac Surgical Procedures↗
PubMed1992

Managing quality and reducing risks in ambulatory surgery.

This article reviews the evolution of quality assurance and continuous quality improvement (QA/CQI) in ambulatory surgery centers. As an example, The QA/CQI Plan of the Gumenick Ambulatory Care Center is examined in detail.

Ambulatory Surgical Procedures↗
PubMed2004

Parathyroid surgery is associated with a decreased risk of hip and upper arm fractures in primary hyperparathyroidism: a controlled cohort study.

OBJECTIVES: To study if parathyroid surgery reduced fracture risk in patients with primary hyperparathyroidism. DESIGN: Controlled cohort study. SETTING: All subjects diagnosed with primary hyperparathyroidism (ICD8 codes: 252.00, 252.01, 252.03, 252.04, 252.05, 252.08, 252.09, and ICD10 codes: E21.0, E21.2, E21.3) between 1980 and 1999 in Denmark were retrieved from the National Hospital Discharge System. SUBJECTS: A total of 3213 subjects (mean age at diagnosis 60.9 +/- 16.3 years) were identified of whom 1934 (60%) had parathyroid surgery whilst 1279 (40%) did not. Total follow-up time after diagnosis was 19.565 (median 6.1) years. MAIN OUTCOME MEASURE: Fracture occurrence after diagnosis was identified from the National Hospital Discharge System. RESULTS: Conservatively treated patients were older than surgically treated at diagnosis (64.2 +/- 17.4 years vs. 58.3 +/- 15.2 years, P < 0.01). The mean serum calcium was 2.95 mmol L-1 in surgically treated and 2.74 in conservatively treated in a subgroup from one centre, n = 687). At the time of diagnosis, 172 (9%) of the subsequently surgically treated had had any fracture whilst the same was the case for 176 (14%) of the conservatively treated (P < 0.05). Parathyroid surgery reduced the risk of hip (HR = 0.44, 95% CI: 0.32-0.62) and upper arm (HR = 0.44, 95% CI: 0.27-0.72) fractures after diagnosis whilst the occurrence of other fracture types remained unchanged. CONCLUSIONS: Parathyroid surgery reduces the occurrence of hip and upper arm fractures with approximately 50% in patients with primary hyperparathyroidism. This may advocate surgery in patients with primary hyperparathyroidism with serum calcium levels in the range presented here. Further studies in patients with mild disease are warranted.

Aged↗
PubMed2006

Falls and health status in elderly women following second eye cataract surgery: a randomised controlled trial.

OBJECTIVE: first eye cataract surgery reduces the risk of falling. Most cataracts in elderly people are bilateral. Some binocular functions (e.g. stereopsis) are associated with falls. We aimed to determine if second eye cataract surgery reduces the risk of falling and to measure associated health gain. STUDY DESIGN AND SETTING: we randomised 239 women over 70, who had been referred to a hospital ophthalmology department, with one unoperated cataract, to expedited (approximately 4 weeks) or routine (12 months wait) surgery. Falls were ascertained by diary, with follow-up every 3 months for 12 months. We measured health status after 6 months. RESULTS: visual function (especially stereopsis) improved in the operated group. Over 12 months follow-up, 48 (40%) operated participants fell at least once, 22 (18%) fell more than once. Forty-one (34%) unoperated participants fell at least once, 22 (18%) fell more than once. Rate of falling was reduced by 32% in the operated group, but this was not statistically significant (rate ratio 0.68, 95% CI 0.39, 1.19, P = 0.18). Confidence, visual disability and handicap all improved in the operated compared with the control group. CONCLUSION: second eye cataract surgery improves visual disability and general health status. The effect on rate of falling remains uncertain.

Accidental Falls↗
PubMed1995

[The prognostic value of common predictive variables in rectal cancer].

BACKGROUND: A study was undertaken to identify common clinical variables, easy to obtain in an out-patient office, that complement the prognostic estimation on survival offered by the staging classification in patients operated on for rectal cancer. PATIENTS AND METHODS: 236 patients were included. Twenty-one variables related to symptoms, examinations, type of operation, tumor stage, pathology and follow-up were evaluated, all of them were collected prospectively. The relative predictive value was analyzed by means of the Cox' proportional hazards progression model. RESULTS: Age, carcinoembryonic antigen (CEA), alcaline fosfatase (FA), deshidrogenase lactate (LDH), elective surgery, showed independent predictive value. The risk of death raised by 1.026 (CI 95%: 1.005-1.047) for each year of age at the moment of surgery, serum CEA over 5 ng/ml raises the risk by 2.32 (IC 95%: 1.385-3.893), LDH over 190 mU/ml by raises the risk by 1.64 (IC 95%: 1.026-2.639), FA over 250 U/ml raises the risk by 2.16 (IC 95%: 1.027-4.578), elective surgery reduces the risk by 0.32 (IC 95%: 0.106-0.965). CONCLUSIONS: Age, CEA, LDH, FA and elective surgery, complement the prediction on survival offered by the tumor stage in patients operated on for rectal cancer.

Chi-Square Distribution↗
PubMed2001

Glaucoma surgery with or without adjunctive antiproliferatives in normal tension glaucoma: 2 Visual field progression.

BACKGROUND: Reduction of intraocular pressure by 20-30% with glaucoma drainage surgery slows disease progression in normal tension glaucoma (NTG). It is not clear whether adjunctive antiproliferative agents are necessary or safe in eyes at low risk for scarring. METHOD: 61 eyes of 61 white patients with NTG who had undergone a primary guarded fistulising procedure were reviewed. 20 eyes had no antiproliferatives (nil), 29 had peroperative 5-fluorouracil (5-FU), and 12 had peroperative mitomycin C (MMC). Pointwise linear regression analysis (PROGRESSOR for Windows software) was applied to their visual field series starting with the first visual field following surgery and adding subsequent visual fields one at a time. Progression of visual field loss was defined as the appearance of a regression slope 1 dB per year or more with a significance of p<0.01 at one or more visual field locations which remained consistent with the addition of two of three successive visual fields. Time updated covariate analysis was used to determine the relation between variables that changed with time, such as IOP, and the risk of progression. RESULTS: The median percentage IOP reduction was 24.4 for the nil group, 38.0 for the 5-FU group, and 47.5 for the MMC group (p=0.001). There was a statistically significant relation between percentage change in IOP and risk of visual field progression in the subsequent 6 month period for all patients analysed as one group, hazard ratio = -0.021 (p=0.002). There was a statistically significantly increase in the risk of visual field progression for the MMC group compared with the 5-FU group, hazard ratio = 1.51 (p=0.02). CONCLUSION: In NTG patients, the IOP reduction produced by drainage surgery reduces the risk that visual field progression may be reduced after drainage surgery; this is related to the level of IOP reduction. The percentage drop in IOP during a given time is related to the risk of subsequent visual field progression. However, the use of MMC is associated with a greater risk of visual field progression despite a greater fall in IOP. This visual field deterioration may be related to the functional loss produced by late postoperative complications which have been reported at a higher rate in this group. The use of adjunctive perioperative 5-FU should maintain a suitable target IOP with preservation of visual function without the additional complications and associated visual deterioration seen with adjunctive MMC.

Aged↗
PubMed2005

Falls and health status in elderly women following first eye cataract surgery: a randomised controlled trial.

BACKGROUND/AIM: A third of elderly people fall each year. Poor vision is associated with increased risk of falls. The authors aimed to determine if first eye cataract surgery reduces the risk of falling, and to measure associated health gain. METHODS: 306 women aged over 70, with cataract, were randomised to expedited (approximately 4 weeks) or routine (12 months wait) surgery. Falls were ascertained by diary, with follow up every 3 months. Health status was measured after 6 months. RESULTS: Visual function improved in the operated group (corrected binocular acuity improved by 0.25 logMAR units; 8% had acuity worse than 6/12 compared with 37% of controls). Over 12 months of follow up, 76 (49%) operated participants fell at least once, and 28 (18%) fell more than once. 69 (45%) unoperated participants fell at least once, 38 (25%) fell more than once. Rate of falling was reduced by 34% in the operated group (rate ratio 0.66, 95% confidence interval 0.45 to 0.96, p = 0.03). Activity, anxiety, depression, confidence, visual disability, and handicap all improved in the operated group compared with the control group. Four participants in the operated group had fractures (3%), compared with 12 (8%) in the control group (p = 0.04). CONCLUSION: First eye cataract surgery reduces the rate of falling, and risk of fractures and improves visual function and general health status.

Accidental Falls↗
PubMed2001

Does off-pump coronary artery bypass surgery reduce mortality in high risk patients?

BACKGROUND: The aim of this retrospective study was to compare outcome in two groups of patients who were classified according to their risk groups and underwent coronary revascularization with or without cardiopulmonary bypass. MATERIAL AND METHODS: Between January 1996 and July 2000, 480 cases that underwent coronary artery bypass surgery (CABG) were included in a retrospective nonrandomized manner for study. Group 1 included 210 patients who were revascularized using off-pump techniques. Octopus 2 and 3 (Medtronic, Inc., Minneapolis, MN) were used for tissue stabilization. Group 2 included 270 cases who underwent CABG using CPB. Emergency cases, combined operations, reoperations, and patients in cardiogenic shock were excluded. Demographic variables were comparable between two the groups. Using the Allegheny Clinic Risk Scoring Scale [Magovern 1996], patients in both groups were scored as low, moderate, and high risk. In Group 1, 37 % of patients consisted of high risk patients while Group 2 had 14% (p < 0.05). Student's t-test and chi-square test were used for statistical analysis and alfa < 0.05 was considered significant. RESULTS: Mortality was 1.4% in Group 1 and 1.5% in Group 2 (p = ns). Mean anastomosis per patient was 2.6 +/- 0.6 in Group 1 and 3.2 +/- 0.5 in Group 2 (p < 0.05). Patients in Group 1 needed less blood transfusions and less inotropic support postoperatively (p < 0.05). There were also fewer minor neurological events (p < 0.05) and pulmonary complications (Type 2) in Group 1. Atrial fibrillation rate, infection, and major neurological deficit (Type 1) were similar in both groups. Mortality was less among Group 1 high risk patients (3.9 %) in comparison to Group 2 high risk patients (7.9 %), but this did not reach statistical significance. CONCLUSIONS: In low or moderate risk patients, CABG can be performed safely with or without CPB. In high risk patients with several comorbidities, off-pump CABG seems to be a safe and efficient method that can improve outcome.

Aged↗
PubMed2002

Risk factors for reduced corneal endothelial cell density before cataract surgery.

PURPOSE: To assess the prevalence and risk factors for reduced endothelial cell density before cataract surgery. SETTING: Ohtsuki Eye Clinic, Sendai, Japan. METHODS: The records of 1304 eyes of 700 consecutive Japanese patients who had cataract surgery from 1995 through 2000 were retrospectively reviewed. The incidence of reduced endothelial cell density to less than 2000 cells/mm(2) was calculated, and potential risk factors for the reduced density were analyzed using logistic regression analysis. RESULTS: The mean preoperative endothelial cell density was 2561.4 cells/mm(2) +/- 375.2 (SD). Reduced endothelial cell density was observed preoperatively in 123 eyes (9%) of 85 patients (12%). In these patients, factors responsible for the decrease were identified in 37 eyes (30%) of 28 (33%) patients. Logistic regression analysis revealed that corneal diseases (P =.003), angle-closure glaucoma (P =.004), pseudoexfoliation (P =.031), and a history of trauma (P <.001) were significantly associated with reduced endothelial cell density. Advanced nuclear cataract and chronic pulmonary disease were also significant risk factors (both P <.001). A subset quantitative comparison study showed that the mean endothelial cell densities in the subgroups of eyes with these risk factors were significantly less than those in a control group (P <.05, analysis of variance). CONCLUSIONS: Approximately 10% of patients had reduced endothelial cell density before cataract surgery; the reason for the reduction was unknown in two thirds. Advanced nuclear cataract and chronic pulmonary disease were significant risk factors for reduced density. Although the mechanisms are unknown, cataract surgeons should recognize that patients with these risk factors may have a poor endothelial reserve.

Aged↗
PubMed2001

Outcomes of noncardiac surgery after coronary bypass surgery or coronary angioplasty in the Bypass Angioplasty Revascularization Investigation (BARI).

PURPOSE: Previous studies have shown that coronary artery bypass surgery reduces the risk of cardiac complications after noncardiac surgery. Whether coronary angioplasty provides equivalent protection is not known. SUBJECTS AND METHODS: Patients were randomly assigned to undergo cardiac artery bypass surgery or angioplasty as part of the Bypass Angioplasty Revascularization Investigation trial. All subsequent noncardiac surgeries during a mean (+/- SD) follow-up of 7.7 years were recorded among participants in the ancillary Study of Economics and Quality of Life. Rates of mortality and nonfatal myocardial infarction, length of stay, and hospital costs were compared by the original randomized assignment. RESULTS: A total of 501 patients had noncardiac surgery at a median of 29 months after their most recent coronary revascularization procedure. Mortality and nonfatal myocardial infarction within 30 days of the first noncardiac surgery occurred in 4 of the 250 of the surgery-assigned patients and in 4 of the 251 of the angioplasty-assigned patients (P = 1.0). There were no significant differences in the mean length of hospital stay (6.3 +/- 6.7 versus 6.2 +/- 6.8 days; P = 0.47) or hospital cost ($8,920 +/- $11,511 versus $7,785 +/- $7,643; P = 0.33) between the surgery and angioplasty groups. Similar results were obtained when subsequent noncardiac procedures were included in the analysis. CONCLUSION: Rates of myocardial infarction and death after noncardiac surgery are similarly low after contemporary bypass surgery or angioplasty in patients with multivessel coronary artery disease.

Aged↗
PubMedDate not supplied

Prophylactic surgery to reduce breast cancer risk: a brief literature review.

Prophylactic mastectomy reduces the likelihood of developing breast cancer among women at heightened risk for breast cancer, but at significant personal cost. Women at increased breast cancer risk on the basis of hormonal history, family history and/or genetic mutation carrier status may consider bilateral prophylactic mastectomy with or without reconstruction to reduce their cancer risk and/or decrease their chances of cancer mortality. Women having received mastectomy as treatment for breast cancer may request contralateral mastectomy to decrease the chances of developing a second breast primary. The potential oncologic value of these procedures must be weighed carefully on a case-by-case basis against the operation's physical and psychological morbidity. The purpose of this literature review is to provide a practice-oriented summary of recent clinical studies attempting to address the relative risks and benefits of preventive surgery for breast cancer. Data are included regarding the psychological factors surrounding patient selection and quality of life outcomes, which become the cornerstone of patient satisfaction and acceptance. Taken together, these data support the Society of Surgical Oncology position statement regarding the proper application of prophylactic surgery for breast cancer.

Breast Neoplasms↗
PubMed1995

The effect of debulking surgery after induction chemotherapy on the prognosis in advanced epithelial ovarian cancer. Gynecological Cancer Cooperative Group of the European Organization for Research and Treatment of Cancer.

BACKGROUND: Although the value of primary cytoreductive surgery for epithelial ovarian cancer is beyond doubt, the value of debulking surgery after induction chemotherapy has not yet been defined. In this randomized study we investigated the effect on survival of debulking surgery. METHODS: Eligible patients had residual lesions measuring more than 1 cm in diameter after primary surgery. After three cycles of cyclophosphamide and cisplatin, these patients were randomly assigned to undergo either debulking surgery or no surgery, followed by further cycles of cyclophosphamide and cisplatin. The study end points were progression-free and overall survival. At surgery 65 percent of the patients had lesions measuring more than 1 cm. In 45 percent of this group, the lesions were reduced surgically to less than 1 cm. RESULTS: Of the 319 patients who underwent randomization, 278 could be evaluated (140 patients who underwent surgery and 138 patients who did not). Progression-free and overall survival were both significantly longer in the group that underwent surgery (P = 0.01). The difference in median survival was six months. The survival rate at two years was 56 percent for the group that underwent surgery and 46 percent for the group that did not. In the multivariate analysis, debulking surgery was an independent prognostic factor (P = 0.012). Overall, after adjustment for all other prognostic factors, surgery reduced the risk of death by 33 percent (95 percent confidence interval, 10 to 50 percent; P = 0.008). Surgery was not associated with death or severe morbidity. CONCLUSIONS: Debulking surgery significantly lengthened progression-free and overall survival. The risk of death was reduced by one third, after adjustment for a variety of prognostic factors.

Adult↗
PubMed2001

Risk factors for preoperative anxiety in adults.

BACKGROUND: Patients who undergo surgery experience acute psychological distress in the preoperative period. The objective of this study was to identify and quantify the effect of risk factors for preoperative anxiety in adults. METHODS: A cross-sectional study was performed with 592 inpatients scheduled for elective surgery. Age ranged from 18 to 60 years (ASA physical status I-III). Demographic information was collected using a structured questionnaire. The measuring instruments were a visual analog scale, the State-Trait Anxiety Inventory; the Montgomery-Asberg Depression Rating Scale, the WHO Self-Reporting Questionnaire-20, and the future self-perception questionnaire. Multivariate conditional regression modeling was used to control confounding factors and to determine independent predictors of preoperative anxiety, taking into account the hierarchical relationship between risk factors. RESULTS: High preoperative anxiety was associated with history of cancer (odds ratio (OR)=2.26) and smoking (OR=7.47), psychiatric disorders (OR=5.93), negative future perception (OR= 2.30), moderate to intense depressive symptoms (3.22), high trait-anxiety (3.83), moderate to intense pain (2.12), medium surgery (OR=1.52), female gender (OR=2.0), ASA category III (OR=3.41), up to 12 years of education (OR=1.36), and more than 12 years of education (OR=1.68). Previous surgery (OR= 0.61) was associated with lower risk for preoperative state-anxiety. CONCLUSIONS: History of cancer and smoking, psychiatric disorders, negative future perception, moderate to intense depressive symptoms, high trait-anxiety, moderate to intense pain, medium surgery, female gender, ASA category III, up to 12 years of education and more than 12 years of education constituted independent risk factors for preoperative state-anxiety. Previous surgery reduced the risk for preoperative anxiety.

Adolescent↗