| Abstract | Ciljevi istraživanja: Bolesnici s karcinomom prostate u prijeoperativnom razdoblju su često
u psihološkom distresu i imaju bolove. Cilj ovog istraživanja je ispitati utjecaj prijeoperativne
anksioznosti, depresivnosti i boli na kvalitetu poslijeoperativnog oporavka (QoR), akutnu
poslijeoperativnu bol i zadovoljstvo bolesnika nakon radikalne prostatektomije.
Ustroj studije: Prospektivno opservacijsko istraživanje.
Ispitanici i metode: Uključeno je 160 bolesnika podvrgnutih otvorenoj ili laparoskopskoj
prostatektomiji. Psihološki distres mjeren je Upitnikom anksioznosti kao stanja i osobine
ličnosti (STAI-S I STAI-O) i Ljestvicom za depresiju Centra za epidemiološka istraživanja
(CES-D), a prijeoperativna bol s Kratkim upitnikom o boli (BPI). Poslijeoperativni oporavak
mjeren je Upitnikom o kvaliteti poslijeoperativnog oporavka (QoR-40) prva tri
poslijeoperativna dana (POD). Jačina poslijeoperativne boli ocijenjena je numeričkom
ljestvicom 0 − 10 u mirovanju i pokretu 1, 6 i 24 sata nakon operacije. Zadovoljstvo bolesnika
s anesteziološkim postupcima ispitano je Bauerovim upitnikom o zadovoljstvu.
Rezultati: Prevalencija anksioznosti mjerene STAI-S ljestvicom iznosi 35%, a prevalencija
depresivnosti, kao i prijeoperativne boli iznosi 21%. Kvaliteta poslijeoperativnog oporavka je
značajno niža kod bolesnika kod kojih je primijenjena retropubična radikalna prostatektomija i
kod onih koji su dobili transfuziju eritrocita. Anksioznost kao stanje je u srednje jakoj
negativnoj korelaciji s ukupnim QoR-40 skorom 1 − 3. POD (-0.418 −-0.428) uz slabe do
srednje jake negativne korelacije sa svim QoR-40 dimenzijama (-0.237 do -0.529).
Anksioznost kao stanje neovisni je prediktor QoR-40 1 − 3. POD (ß = -17,32; p<0,001, ß = -
0,345; p=0,004, ß = -0.326; p=0.002) i klinički značajne boli u pokretu (OR, 2,21; 95%CI, 1,08
− 4,52). Anksioznost kao osobina i depresivnosti u značajnoj su, ali slaboj negativnoj korelaciji
s ukupnim QoR-40 1 − 3. POD. Prijeoperativna bol prediktor je poslijeoperativne boli u
mirovanju (ß = 0,666; p=0,008), boli u pokretu (ß = 0,691; p=0.006) i klinički značajne boli u
mirovanju (OR, 2,86; 95%CI 1,11 − 7,36). Zadovoljstvo anesteziološkim postupcima u slaboj
je negativnoj vezi sa STAI-S i prijeoperativnim skorovima boli. Ukupni skor QoR-40 1.POD
i poslijeoperativna srednja bol u mirovanju prediktori su zadovoljstva s anesteziološkim
postupcima.
Zaključak: Anksioznost kao stanje prediktor je kvalitete poslijeoperativnog oporavka i klinički
značajne poslijeoperativne boli u pokretu nakon radikalne prostatektomije. Prijeoperativna bol
prediktor je poslijeoperativne boli. Anksioznost kao stanje i prijeoperativna bol povezane su s
manjim zadovoljstvom bolesnika anesteziološkim postupcima. |
| Abstract (english) | Research objectives: Patients with prostate cancer are often in psychological distress and pain
preoperatively. The aim of this study was to examine the effects of preoperative anxiety,
depression and pain on the quality of postoperative recovery, acute postoperative pain and
patient satisfaction with anesthesia after radical prostatectomy.
Study design: Prospective observational study
Participants and methods: The study included one hundred and sixty (160) patients scheduled
for open or laparoscopic radical prostatectomy. The State-Trait Anxiety Inventory (STAI-S and
STAI-T) and Center for Epidemiological Studies Depression Scale (CES-D) assessed the
psychological distress. The Brief Pain Inventory (BPI) assessed patients who reported having
preoperative pain. Postoperative recovery was assessed on postoperative days 1-3 using the
Croatian version of Quality of recovery-40 score (QoR-40). A numeric rating scale (NRS) 0-10
was used to assess the intensity of postoperative pain during rest and during movement at 1, 6
and 24 hours post-surgery. Clinically relevant pain during rest and during movement was
defined with NRS ≥4. Satisfaction with anaesthesia was assessed with the Bauer questionnaire
before discharge.
Results: The median value of state anxiety (STAI-S) was 35 (IQR 29-43), trait anxiety (STAIT) was 33 (IQR 28-40), and CES-D was 8 (IQR 4-15). High levels of state anxiety (STAI-S)
were present in 56 (35%) patients and high levels of trait anxiety (STAI-T) in 41 (26%) patients.
High levels of depression were present in 33 (21%) patients. Preoperative pain was present in
33 (20.6%) patients. STAI-S showed moderate negative correlations with global QoR-40 on
POD 1-3 (-0.418 to -0.428), with low to moderate negative correlations with all QoR-40
dimensions (-0.237 to -0.529). The mean NRS for pain during rest was 2.33 (IQR 1.67-3.67)
and the mean NRS for pain during movement was 4.17 (IQR 3.08-5-0). In linear regression
models, STAI-S was the predictor for QoR-40 on postoperative days 1-3 (ß = -17.32; p<0,001,
ß = -0.345; p=0.004, and ß = -0.326; p=0.002 respectively) and preoperative pain was the
predictor for pain during rest (ß = 0.666; p=0.008) and during movement (ß = 0.691; p=0.006).
In logistic regression models, preoperative pain was the predictor for clinically significant pain
during rest (OR, 2.86; 95%CI 1.11-7.36) and STAI-S was for clinically significant pain during
movement (OR, 2.21; 95%CI, 1.08-4.52). Satisfaction with anaesthesia showed weak negative
correlations with STAI-S and preoperative pain. In the linear regression model, QoR-40 on
1.POD (ß = 0,051; p˂0.001) and pain during rest (ß = -0,403; p˂0.001) were predictors of
patient satisfaction with anaesthesia.
Conclusion: State anxiety had a negative impact on QoR and acute pain after a radical
prostatectomy. Preoperative pain was associated with acute postoperative pain. Patient
satisfaction was associated with QoR and postoperative pain during rest |
