Australia & New Zealand Society of Vascular Surgeons

Objectives The present study examined the relationship between pre-operative anxiety, intra-operative neuroendocrine responses and recovery. In line with the psychophysiological model of adjustment to surgery it was predicted that heightened pre-operative anxiety would be associated with increases in intra-operative neuroendocrine responses and poorer recovery. Methods Participants were 39 patients (mean age 71.9 6.1) undergoing elective carotid endarterectomy surgery under local anaesthesia. In the week prior to surgery patients completed baseline measures of physical and mental functioning using the MOS 36-Item Short-Form Health Survey (SF-36). In addition to this they undertook a 24-hour urine save to measure cortisol, adrenaline and noradrenaline. Measures of anxiety were completed on the evening prior to surgery. A second 24-hour urine save was started at the time of anaesthetic induction. Follow-up measures of physical and mental functioning were completed one month following surgery. All complications were recorded during hospitalisation. Results Overall there was a significant increase in cortisol and adrenaline from baseline to surgery (p .05). Pre-operative anxiety was significantly, negatively associated with intra-operative cortisol (r = -.45, p = .004). Using hierarchical regression analysis, pre-operative anxiety significantly explained 10% of the variance in intra-operative cortisol responses after controlling for medical and demographic factors. There were no significant associations between neuroendocrine responses and measures of recovery (complications and HRQoL). Pre-operative anxiety was a significant determinant of poorer mental functioning following surgery, explaining 10% of the variance in scores after adjusting for baseline mental functioning. Conclusions Results from this study challenge the general assumption that increasing pre-operative anxiety is associated with increases in neuroendocrine responses and poorer post-operative recovery.