Checking the moderating effect of perceived control on the relationship between anxiety and postoperative hospital length of stay among coronary artery bypass graft patients

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Abstract

Background

Coronary artery disease (CAD) is the most common cardiovascular disease (CVD). Coronary artery bypass graft (CABG) surgery is the most common treatment used for CAD. Patients undergoing this surgery are always anxious, which might increase complications in the postoperative period, especially prolongation of postoperative length of stay (LOS). It has been shown that perceived control (PC) moderated the relationship between anxiety and complications in a cardiac population, but its effect has not been studied in post-CABG.

Aim

The aim of this study was to check if there is a moderating effect for the PC on the relationship between anxiety and LOS post-CABG.

Patients and methods

A non-experimental, prospective, observational study was conducted with a consecutive sample of 250 patients who underwent elective CABG from four hospitals in Amman, Jordan. PC was measured by the Arabic version of the Control Attitude Scale-Revised (CAS-R), and anxiety was measured by the Arabic version of the anxiety subscale of Hospital Anxiety and Depression Scale. LOS and other needed information were obtained from patients’ medical records.

Results

Preoperative anxiety was significantly higher than postoperative anxiety (mean [SD]: 12.80 [6.70] vs 11.01 [6.74], P<0.001). Female patients were more anxious and had longer LOS compared to male patients. In stepwise regression, anxiety and PC scores were independent predictors for LOS. Every unit increase in preoperative anxiety increased LOS by 0.381 days, and every unit increase in PC decreased the postoperative LOS by 0.210 days. Moderating effect was checked by simple slope analysis for high (+1 SD) and low (−1 SD) levels of PC. Patients with high anxiety and low PC had the longest LOS, and patients with low anxiety and high PC had the shortest LOS, indicating the moderating effect of PC on the relationship between anxiety and LOS.

Conclusion

High levels of anxiety were associated with longer LOS after CABG. PC moderates this relationship. Enhancing PC in this population can improve outcomes and decrease LOS and morbidity.

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Most cited references 39

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Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review

Phillip Tully, Robert Baker (2012)

Research to date indicates that the number of coronary artery bypass graft (CABG) surgery patients affected by depression (i.e., major, minor, dysthymia) approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsychological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.

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Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia

Seifu Nigussie, Tefera Belachew, Wadu Wolancho (2014)

Background Hospitalization and surgery are critical negative life events that lead to the experience of considerable anxiety in patients. Patients may perceive the day of surgery as the biggest and the most threatening day in their lives. There is paucity of information on predictors of anxiety in the current study area. The main objective of this study is to assess predictors of preoperative anxiety among patients scheduled for surgery in Jimma University Specialized Teaching Hospital. Methods A facility based cross-sectional study was conducted using quantitative data collection technique in Jimma University Specialized Teaching Hospital from February 13 to April 13, 2012 on 239 patients scheduled for surgery. The data were collected by five trained diploma nurses using structured interviewer administered questionnaires that were prepared based on state trait anxiety inventory measurement scale. The quantitative data were entered into SPSS for windows version 16. 0 and descriptive, simple and multiple linear regression analyses were performed. Results A total of 239 patients were enrolled in the study with a response rate of 93.0%. Their mean age was 42.7 ± 1.8 years (range 16 to 85 years). Nearly over half 53.6% were females, while 48.1% illiterate, 72.4% Oromo and 56.5% were Muslim followers. Significant preoperative anxiety was seen in 70.3% patients. The most common factors that lead to anxiety were fear of death 38.1% and fear of unknown origin 24.3% and the most common strategy mentioned by patient in reducing anxiety were talking to other patient 79.8% and religious belief. Conclusions In the present study, two third 70.3% of preoperative patients had anxiety. Factors which were positively correlated with anxiety were trait anxiety, single and divorced, time of operation and income. Factors which were shown to reduce anxiety were preoperative anxiety related information provision and afternoon operation. Health professionals working in the hospital should provide anxiety related information for patients.

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A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial.

Ping GUO, Linda Anne East, Antony Arthur (2012)

Patients awaiting cardiac surgery typically experience significant physical and psychological stress. However, although there is evidence that preoperative education interventions can lead to positive postoperative outcomes for surgical patients in general, less is known about the effectiveness among patients undergoing cardiac surgery, especially Chinese cardiac patients. To determine whether a preoperative education intervention designed for Chinese cardiac patients can reduce anxiety and improve recovery. Randomized controlled trial. Cardiac surgical wards of two public hospitals in Luoyang, China. 153 adult patients undergoing cardiac surgery were randomized into the trial, 77 to a usual care control group and 76 to preoperative education group comprising usual care plus an information leaflet and verbal advice. Measurement was conducted before randomization and at seven days following surgery. The primary outcome was change in anxiety measured by the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes were change in depression (HADS), change in pain as measured by subscales of the Brief Pain Inventory-short form (BPI-sf), length of Intensive Care Unit stay and postoperative hospital stay. Of 153 participants randomized, 135 (88.2%) completed the trial. Participants who received preoperative education experienced a greater decrease in anxiety score (mean difference -3.6 points, 95% confidence interval -4.62 to -2.57; P<0.001) and a greater decrease in depression score (mean difference -2.1 points, 95% CI -3.19 to -0.92; P<0.001) compared with those who did not. There was no difference between groups in average pain, current pain, and interference in general activity, mood and walking ability. Patients randomized to the preoperative education group reported less interference from pain in sleeping (mean difference -0.9 points, 95% CI -1.63 to -0.16; P=0.02). There was some evidence to suggest a reduced number of hours spent in the Intensive Care Unit among preoperative education patients (P=0.05) but no difference in length of postoperative hospital stay (P=0.17). This form of preoperative education is effective in reducing anxiety and depression among Chinese cardiac surgery patients. Based upon existing evidence and international practice, preoperative education should be incorporated into routine practice to prepare Chinese cardiac patients for surgery. Copyright © 2011 Elsevier Ltd. All rights reserved.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Gen Med

Journal ID (iso-abbrev): Int J Gen Med

Journal ID (publisher-id): International Journal of General Medicine

Title: International Journal of General Medicine

Publisher: Dove Medical Press

ISSN (Electronic): 1178-7074

Publication date Collection: 2019

Publication date (Electronic): 30 January 2019

Volume: 12

Pages: 79-85

Affiliations

Clinical Nursing Department, Faculty of Nursing, Applied Science Private University, Amman 11934, Jordan, mohannadeid@ 123456yahoo.com

Author notes

Correspondence: Mohannad Eid AbuRuz, Clinical Nursing Department, Faculty of Nursing, Applied Science Private University, PO Box 142, Shafa Badarn, Amman 11934, Jordan, Tel +962 79 026 2408, Fax +962 65 23 2899, Email mohannadeid@ 123456yahoo.com

Article

Publisher ID: ijgm-12-079

DOI: 10.2147/IJGM.S192333

PMC ID: 6363494

PubMed ID: 30787628

SO-VID: 851284b7-ef92-45d1-88e3-6a5afe488ae0

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Checking the moderating effect of perceived control on the relationship between anxiety and postoperative hospital length of stay among coronary artery bypass graft patients

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Abstract

Background

Aim

Patients and methods

Results

Conclusion

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The International Journal of Person Centered Medicine

Most cited references 39

Depression, anxiety, and cardiac morbidity outcomes after coronary artery bypass surgery: a contemporary and practical review

Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia

A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial.

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