The preoperative psychiatric consultation in live kidney donor patients and its perioperative and postoperative effects

Kidney transplantation is an effective treatment method for patients with end-stage renal disease, aiming to improve quality of life, provide a healthy and prolonged lifespan, and eliminate the need for dialysis. However, this process involves not only physical and psychological recovery but also requires psychological adjustment. Kidney transplantation is a significant source of stress for both the donor and the recipient. The psychological stress experienced by donors, especially during the preoperative period, can alter the course of the surgical process and recovery phase. This study was conducted to assess the effects of preoperative anxiety levels in kidney donors on intraoperative and postoperative hemodynamic parameters, postoperative pain scores, and clinical outcomes. This prospective study included a total of 123 adult patients classified as ASA-1 and ASA-2 who underwent living kidney donor surgery at the Prof. Dr. Tuncer Karpuzoğlu Organ Transplantation and Robotic Surgery Center of Akdeniz University Faculty of Medicine between November 1, 2023, and November 1, 2024. Data from the patients were obtained through the hospital information management system and archive review. Preoperative data were collected from the patients' anesthesia and surgical preoperative history records; intraoperative data were obtained from anesthesia evaluation and monitoring forms recorded in the operating room; postoperative data were gathered from the patient follow-up forms kept during the hospital stay. The patients were randomly divided into two groups. In the control group, the patients' demographic data, preoperative hemodynamic parameters, and BECK anxiety scores, hemodynamic parameters before anesthesia induction (blood pressure, heart rate, SpO₂), postoperative hemodynamic parameters, BECK anxiety scores, VAS pain scores, complications, analgesic and antiemetic drug requirements and dosages, and preoperative and postoperative laboratory values (leukocytes, NLR, MPV, CRP, 82 glucose) were recorded. In the intervention group, the same parameters were recorded as in the control group, and approximately 1 hour before the operation, a psychiatric consultation lasting about 15 minutes was performed by a psychiatrist during the ward admission. During this process, a conversation was held with the patient, information about anxiety was provided, and a diaphragmatic breathing exercise along with an imagination-based anxiety reduction application was conducted. In our study, a total of 123 patients were examined, with 63 in the control group and 60 in the intervention group. No significant difference was observed between the two groups in terms of demographic data. In the intervention group, postoperative Beck anxiety scores at the 24th and 48th hours were significantly lower (p<0.001). There was no significant difference between the groups in terms of preoperative and postoperative laboratory parameters, hemodynamic parameters before anesthesia induction, and intraoperative hemodynamic parameters. When comparing postoperative hemodynamic parameters and pain scores between the two groups, the intervention group had a higher SpO₂ value at the 2nd hour (p<0.05) and lower pain scores at the 12th and 24th hours (p<0.001). When comparing postoperative analgesic dosage requirements, no significant difference was found in tramadol dosage; however, the need for paracetamol was significantly lower in the intervention group between 0-24 hours and 0-48 hours (p<0.001). When comparing nausea between the groups, the intervention group had significantly lower nausea between 0-12 hours (p<0.01). This study demonstrates that preoperative psychiatric intervention reduces anxiety levels and positively affects postoperative hemodynamic parameters and pain levels. These findings support the application of psychiatric support as a standard treatment in surgical processes. Future multicenter studies with larger sample sizes may help increase the knowledge base related to this study.