The impact of preoperative anxiety on patients undergoing brain surgery: a systematic review

Vittorio Oteri
Università degli Studi di Catania


Introduction: Preoperative anxiety is a common reaction exhibited by up to 80% of patients who are scheduled for surgical procedures and characterized by psychological and physical changes which may affect their perioperative period. Our aim is to report the most up-to-date evidence on preoperative anxiety in brain surgery patients through a systematic analysis of the studies produced in the last decades.

Methods: We performed a systematic review of literature by searching PubMed, Embase, and Cochrane Library databases. Data were extracted using the PICO framework and critically analyzed. PRISMA guidelines were applied, and the risk of bias of the included studies was assessed using the RoB 2 and ROBINS tools, as was the methodological quality, following GRADE criteria.

Results: We included 27 articles, accounting for 2558 patients in twelve different countries. The prevalence of clinically relevant (mild or moderate at least) preoperative anxiety ranged from 17% up to 89%, with severe/high anxiety affecting up to 55% of patients; preoperative anxiety was higher in women than men, and it was mainly related to surgery outcome and anesthesia.
Preoperative anxiety could lead to a lower health-related quality of life, lower cognitive performance and self-perception of worse memory and attention during preoperative period, worsening the perception of patient’s own capability and safety during surgery and anesthesia.
Preoperative anxiety could have implications on various aspects of postoperative period of brain tumor patients, such as depressive symptoms, decrease in quality of life, and increase of physical disability, although no correlation between preoperative anxiety and survival rate was found.
Seven Randomized Controlled Trials attested the efficacy of acupuncture, music therapy, virtual reality, and pharmacological support in lowering anxiety levels.

Discussion and conclusions: The main limitation of this review was due to heterogeneity in the included studies, not allowing us to perform a quantitative synthesis through meta-analysis. From the methodological side, the strict adherence to PRISMA and Cochrane guidelines and the rigorous assessment of the quality and risk of bias of the included studies through highly reliable tools can be considered a strength of our work. Preoperative anxiety is a common phenomenon that could negatively affect the perioperative period of brain surgery patients: this is something that should not be neglected to achieve better care through early prevention and optimal management of neuropsychological and emotional concerns of the patients during their pathway of care; this needs to be achieved especially through the inclusion of specialized mental health professionals into the standard-of-care team.

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3- Stamenkovic DM, Rancic NK, Latas MB, Neskovic V, Rondovic GM, Wu JD, Cattano D (2018) Preoperative anxiety and implications on postoperative recovery: What can we do to change our history.

The impact of preoperative anxiety on patients undergoing brain Surgery: a systematic review – Vittorio Oteri (Università degli Studi di Catania)