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Analysis of Factors Contributing to Perioperative Mohs Micrographic Surgery Anxiety: Patient Survey Study at an
Ryan E Kokoska1, Mindy D Szeto2, Laryn Steadman3
1Department of Dermatology, Indiana University School of Medicine, Indianapolis, Indiana.
Background:
High perioperative patient anxiety is predictive of worse postoperative pain and quality of life. Several Mohs micrographic surgery (MMS) patient characteristics influence anxiety; however, the contributions of certain factors remain uncertain.
Objective:
Investigate factors influencing perioperative MMS patient anxiety, especially those with debated impact or unclear data.
Methods:
The authors surveyed 145 adult patients receiving MMS performed by a single MMS surgeon from 2018 to 2020. Patients self-reported demographics, history, and 10-point visual analog scale anxiety assessments at multiple stages. Health care provider (HCP)-perceived anxiety assessments were queried. A stepwise multiple regression modeling approach was used to explore potential factors.
Results:
Younger age, female sex, and a self-reported history of anxiety confirmed by prior HCP diagnosis were significant predictors of pre-MMS anxiety. Postoperative anxiety increased with more layers removed and higher pre-MMS anxiety. HCP-perceived patient anxiety increased with younger patient age, more layers removed, prior skin cancer removal, and HCP-perceived pre-MMS patient anxiety.
Conclusion:
Anxiety-reducing interventions should target young female patients with a history of HCP-diagnosed anxiety, and patients with more layers removed. Prior skin cancer removal is associated with increased HCP-perceived intraoperative patient anxiety; however, it is not significant for patient-reported anxiety. Pre-MMS consultation may not be effective for anxiety reduction.
Insights
High patient anxiety before Mohs surgery (MMS) impacts outcomes. Younger age, female sex, and prior anxiety history predict higher anxiety, alongside more layers removed. Interventions should target these high-risk groups.
Area of Science:
- Dermatology
- Psychology
- Surgical Oncology
Background:
- Perioperative anxiety significantly impacts postoperative pain and quality of life.
- Patient characteristics influencing anxiety during Mohs micrographic surgery (MMS) are not fully understood.
- Identifying key anxiety predictors in MMS patients is crucial for targeted interventions.
Purpose of the Study:
- To investigate factors influencing perioperative anxiety in patients undergoing Mohs micrographic surgery (MMS).
- To clarify the impact of specific patient characteristics on anxiety levels before, during, and after MMS.
- To identify patient subgroups at higher risk for perioperative anxiety.
Main Methods:
- A survey was administered to 145 adult patients undergoing MMS.
- Data collected included patient demographics, medical history, and self-reported anxiety via a 10-point visual analog scale.
- Health care provider (HCP)-perceived anxiety and stepwise multiple regression modeling were utilized.
Main Results:
- Younger age, female sex, and a history of anxiety (HCP-diagnosed) were significant predictors of pre-MMS anxiety.
- Increased layers removed and higher pre-MMS anxiety correlated with greater postoperative anxiety.
- HCP-perceived anxiety was linked to younger age, more layers removed, prior skin cancer removal, and higher perceived pre-MMS anxiety.
Conclusions:
- Anxiety-reducing interventions should focus on young females with a history of diagnosed anxiety and patients requiring more surgical layers.
- Prior skin cancer removal increases HCP-perceived anxiety but not patient-reported anxiety.
- Pre-MMS consultations may not effectively reduce patient anxiety.
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