Psychological Triggers in the Operating Room Before Induction: A Postoperative Analysis Among Adult Patients...

Negative preoperative psychological experiences (eg, anxiety, stress) are identified as the worst component of surgery by patients and can be associated with poor outcomes. This exploratory study aimed to examine which stimuli within the operating room (OR) were associated with elevations in patient-reported anxiety, discomfort, or stress, before anesthesia induction.

A retrospective semi-structured interview was performed in the acute postoperative period (mean of 7.5 days, standard deviation = 3.3).

Adult patients who previously underwent elective surgery under general anesthesia were invited to participate. Participants reported on psychological responses to the cool OR room temperature, music playing, health care provider discussions, bed position, anesthetic mask application, and "other" stimuli (open-ended). Descriptive statistics examined self-reported anxiety, stress, or discomfort associated with each stimulus and a qualitative content analysis identified other provoking elements from open-ended responses.

Among 300 patients, the most psychologically provoking stimuli were the application of the anesthetic mask (21%), followed by the cool OR room temperature (11%), the bed position (9%), discussions among health care providers (3%), and music playing (0.3%). Other (open-ended) stimuli were reported by 23% of respondents and content analysis revealed themes of staff professionalism, and procedural and OR equipment/surgical instruments impacting adverse psychological responses. Younger patients (t = 2.3, P ≤ .05), patients who were interviewed more recently following surgery (t = 2.0, P ≤ .05), and patients from one of the two hospitals (χ² = 11.8, P ≤ .01) more often reported having "any" adverse psychological response in the OR.

This study examined environmental stimuli within the OR associated with patient-reported negative psychological experiences. Simple modifications of OR factors may be effective for reducing anxiety, discomfort, and stress and improving patient care and satisfaction.