The prevalence of preoperative anxiety and the relationship between preoperative anxiety and postoperative pain outcomes in patients undergoing total hip and knee replacements

Aim: This study aimed to determine the prevalence of preoperative anxiety in patients undergoing total hip and knee replacements and the relationship between preoperative anxiety and postoperative pain outcomes. Method: This descriptive, correlational cross-sectional study was conducted in Antalya Kepez State Hospital Orthopedic Clinic between June 2021-June 2022 with 104 participants (87 total knee prosthesis-TKP/17 total hip prosthesis-THP). Data were collected in three pre- and post-operative stages with the "Personal Information Form", "State-Trait Anxiety Inventory" (STAI), "Visual Analogue Scale" (VAS) and "Revised American Pain Society Patient Outcome Questionnaire" (APS-POQ-R). Findings: Preoperative anxiety prevalence was high in 80.8%, moderate in 12.5% and low in 6.7% of individuals undergoing THP and TKP. Mean preoperative STAI-I and STAI-II scores were 53.95±10.51 and 44.20±10.55, respectively. A moderate positive correlation was found between STAI-I and VAS pain scores preoperatively and at 6, 12, 24 and 36 hours postoperatively. Male gender, undergoing THP and an increasing STAI-I score increased the 6th-hour VAS pain score, while male gender, undergoing THP and an increasing STAI-II score increased the 12th-hour VAS pain score. Satisfaction with the results of APS-POQ-R pain management was high (7.42±1.51). There was a strong positive correlation between participants' STAI-I scores and their "Emotional Effect" sub-dimension scores (r=0.626;p<0.001), and a moderate positive correlation with their "Pain Severity and Effect on Sleep" (r=0.595;p<0.001) and "Effect on Activity" scores (r=0.553;p<0.001), while there was a weak positive correlation between participants' STAI-II scores and their "Pain Severity and Effect on Sleep" (r=0.249;p=0.011), "Effect on Activity" (r=0.252;p=0.010) and "Emotional Effect" (r=0.286;p=0.003) scores. Conclusion: In this study, the prevalence of high preoperative anxiety in participants undergoing THP and TKP was 80.8%. Preoperative high state anxiety was associated with early postoperative pain outcomes. Keywords: Total hip replacement, total knee replacement, preoperative anxiety, postoperative pain, patient outcomes.