Incidence, Associated Risk Factors, and Outcomes of Postoperative Anxiety in Elderly: a retrospective study

doi:10.21203/rs.3.rs-4872728/v1

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Incidence, Associated Risk Factors, and Outcomes of Postoperative Anxiety in Elderly: a retrospective study

https://doi.org/10.21203/rs.3.rs-4872728/v1

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Background

Research on postoperative anxiety (POA), especially in elderly, is limited. The relevance of POA for patients’ outcomes is unknown. We aimed to ascertain the incidence, identify potential risk factors and investigate the immediate outcomes of POA.

Methods

This retrospective cohort study analyzed elderly who underwent surgery in our hospital between May 1, 2020, and March 31, 2021. Perioperative anxiety was evaluated with the Generalized Anxiety Disorder Questionnaire-7. A multivariable logistic regression was used to assess associations between perioperative data and occurrence of POA.

Results

A total of 308 patients were analyzed. POA was recorded in 160 patients within 7 days after surgery (51.9%). The incidence of POA was associated with worsened postoperative sleep quality (PSQ) and pain. Preoperative anxiety (OR, 3.60; 95% CI, 1.76–7.40) and preoperative sleep disturbance (OR, 3.34; 95% CI, 1.82–6.13) were identified as independent risk factors of POA. Patients who developed POA exhibited significantly higher 24 h pain VAS scores and worsen PSQ scores on postoperative day 1, 2 and 3. Anxiety at 30 and 90 days after surgery was significantly increased compared with those without POA.

Conclusion

Our study indicates that POA is prevalent and associated with immediate postoperative outcomes.

anxiety

pain

sleep quality

elderly

Anxiety disorders, characterized by excessive fear, anxiety, or avoidance of perceived threats, represent a prevalent category of mental disorders ¹. Clinically significant anxiety symptoms are reported in 15–52% of individuals in community samples, and this range extends to 15–56% in medical settings ². However, the true prevalence of anxiety disorders in the elderly population may be underestimated due to diagnostic and assessment challenges.

The perioperative period presents numerous triggers for anxiety in elderly patients undergoing anesthesia and surgery, including concerns about surgical outcomes, future uncertainty, anesthesia safety, postoperative pain and complications, loss of independence, caregiver burden, and fear of mortality ^3–7. Preoperative anxiety incidence varies widely across clinical disciplines, ranging from 11–80% ⁸. Despite the potential occurrence of perioperative anxiety both pre- and post-surgery, postoperative anxiety (POA) has traditionally received less attention. Consequently, anesthesiologists are increasingly interested in identifying and treating POA. With the global aging trend, the number of elderly patients requiring surgery is expected to rise significantly, suggesting a corresponding increase in perioperative anxiety incidence. This poses a substantial public health concern for the foreseeable future.

Perioperative anxiety is recognized as a detrimental factor affecting postoperative outcomes. However, current research predominantly focuses on preoperative anxiety. Studies have linked preoperative anxiety to various perioperative outcomes, including exacerbated postoperative pain ^9–12, increased postoperative delirium ¹³, heightened postoperative complications ¹⁴, prolonged hospital stay ¹⁵, reduced postoperative quality of life ^9,14,16, and even as an independent risk factor for postoperative mortality ¹⁷. Research on the impact of POA remains limited. Recent literature review indicates that the incidence of POA in elderly patients ranges from 5–38% based on various surgical procedures and assessment scales ¹⁸. A retrospective study found that POA in patients with endometrial cancer was associated with increased postoperative pain and significant immune function reduction ¹⁹. While preoperative anxiety is closely linked to the onset of POA ³, the role of POA in patient recovery post-surgery warrants further attention.

This study aims to (1) determine the incidence of POA through retrospective analysis of data from elderly patients who underwent surgical procedures, (2) identify potential risk factors for POA, and (3) investigate the immediate outcomes of POA.

Study design and patient selection

The study protocol (ethical number: 2019 KEY-E-115) obtained approval from the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University and adhered to the STROBE guidelines ²⁰. The research, conducted in accordance with the Helsinki Declaration, ensured patient data confidentiality.

The study included records of elderly patients aged 65 to 90 years who underwent elective non-cardiac and non-neurosurgical procedures, under general anesthesia at the First Affiliated Hospital of Guangxi Medical University between May 1, 2020, and March 31, 2021. Patient selection criteria followed the American Society of Anesthesiologists (ASA) classification I ~ IV, with exclusion criteria comprising emergency surgery, communication disorders, drug dependence, history of mental illness, and sedative use in the past week. Throughout the entirety of the study period, patients with missing preoperative or intraoperative relevant information were also excluded from the analysis. Surgeries were categorized into general, orthopedic, and urological procedures based on the surgical site.

Data Collection Protocol

As our team is dedicated to researching the perioperative recovery of elderly patients, routine evaluations are conducted in our hospital to assess frailty, anxiety, sleep quality, and cognitive function etc. among elderly surgical patients. Furthermore, informed consent forms have been obtained, signed either by the patients themselves or their family members.

Preoperative and Intraoperative Data

Demographic data including gender, age, Body Mass Index (BMI), frailty, preoperative comorbidities, smoking and drinking habits, educational level, cognitive function status, and sleep conditions were extracted from the electronic medical records and anesthesia visit system. Cognitive impairment was defined as the Minimum Mental State Examination (MMSE) score of ≤ 20 with education ≤ 6, MMSE score of ≤ 24 with education>6 ²¹, Frailty was defined as the FRAIL Score>2 ²², preoperative sleep disturbance defined as the sleep-NRS score ≥ 6 ²³.

Intraoperative data, such as surgery duration, estimated blood loss, episodes of hypotension, administration of opioid drugs (fentanyl equivalent doses for various opioids), and peripheral nerve blockade, were documented. Intraoperative hypotension is defined as a systolic blood pressure lower than 90 mmHg or a decrease of more than 20% from baseline. Given the potential impact of dexmedetomidine on anxiety ^24,25, we also recorded the intraoperative utilization of dexmedetomidine.

Postoperative Follow-Up Data

Postoperative sleep quality (PSQ) was assessed using the Numeric Rating Scale (NRS) on the first three postoperative nights, with scores ranging from 0 (best possible sleep) to 10 (worst). Postoperative pain intensity was evaluated 24 hours post-surgery using the Visual Analog Scale (VAS), where scores ranged from 0 (no pain) to 10 (unbearable pain). Patients with VAS scores exceeding 4 received rescue analgesia with flurbiprofen, and the need for rescue analgesia was recorded.

Postoperative delirium (POD) was assessed for 7 days post-surgery using the Confusion Assessment Method (CAM) through twice-daily assessments. ²⁶. The CAM is a structured interview that evaluates four clinical criteria: acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. Delirium was diagnosed if the first two criteria and either the third or the fourth criterion were present. POD was diagnosed if CAM criteria were met on any of the assessments, with medical records and family interviews also reviewed for signs of delirium, such as confusion, agitation, hallucinations, delusions, and sedation.

Anxiety status evaluation

All participants were assessed for anxiety according to the Generalized Anxiety Disorder Questionnaire (GAD-7), which evaluate the frequencies at which certain symptoms had been experienced over the last two weeks, ranging from 0 (‘not at all’) to 3 (‘nearly every day’). These questionnaires were self-administered. The cutoff values of GAD-7, scores range from 0 to 21, with scores over 4 indicating anxiety ^27,28. All participant were assessed anxiety status at various time points: preoperative and postoperative days 1, 3, 7, 30, and 90 during the research. During the hospitalization, patients were assessed in-person by a trained staff member. If discharged, follow-up evaluations are conducted via telephone. Postoperative anxiety (POA) was defined as anxiety occurring within the first 7 days after surgery, with its influence on POA at 30- and 90 days post-surgery were also examined.

Statistical Analysis

The sample size for this retrospective study was calculated based on the estimated incidence of POA in elderly surgical patients. Considering a margin of error of 5%, a confidence level of 95%, and an anticipated POA incidence of 30% based on preliminary data, after accounting for potential missing data (20%), 463 patients was deemed sufficient to achieve the study objectives with adequate statistical power.

Descriptive statistics were presented as mean (standard deviation) or median (interquartile range) for continuous variables, and as counts (percentages) for categorical variables. A univariate logistic regression analysis was conducted on all variables in patients without POA versus those with POA using chi-square test, Fisher’s exact test, independent t-test, or Mann-Whitney U test, as appropriate.

The Least Absolute Shrinkage and Selection Operator (LASSO) regression was employed to execute the multivariate logistic regression. This method employs L1-penalized least absolute shrinkage and selection regression for multivariable analyses, which is further augmented with 10-fold cross-validation for internal validation. The most predictive covariates were selected by the minimum (λ min). Subsequently, based on prior research findings and the results obtained from Lasso and univariate logistic regression analysis, eight risk factors, including gender, BMI, education level, preoperative anxiety, preoperative sleep disturbance, surgery type, use of peripheral nerve block and use of dexmedetomidine, were incorporated into the multiple regression model.

We also explored whether postoperative anxiety had an impact on patients' postoperative clinical outcomes. To minimize potential confounding factors, we adjusted the outcomes of binary variables based on the results of univariate logistic regression (P < 0.05). For continuous variables, we similarly adjusted for relevant covariates and compared using the method of least squares mean differences. All data were analyzed using SPSS 22.0 and R statistical software. A two-tailed P value less than 0.05 was deemed statistically significant.

A comprehensive review was conducted on a total of 14,409 patients who underwent elective surgery under general anesthesia at the First Affiliated Hospital of Guangxi Medical University from May 1, 2020, to March 31, 2021. Following the initial screening, 489 patients met the inclusion criteria. However, due to missing preoperative or intraoperative data, 181 patients were excluded, leaving 308 patients for the final analysis.

Demographic and Intro-operative Data

The cohort comprised 308 patients (median [IQR] age, 70 [67–75] years; 168 [54.5%] men and 140 [45.5%] women) who underwent elective surgery. The surgical procedures encompassed 157 (51.0%) elective general, 96 (31.2%) orthopedics, and 55 (17.8%) urinary surgery. In the preoperative health assessment of all patients, 88 patients (28.6%) were identified with preoperative anxiety, 62 (20.1%) exhibited frailty, and 83 patients (26.9%) had sleep disturbance. Approximately 38.7% of patients received PNB for multimodal analgesia, and 228 (74.0%) experienced hypotension during anesthesia and surgery. Table 1 presents all demographic and clinical data of the enrolled patients.

Table 1

Patient demographics and baseline characteristics
Various	Overall, N = 308	male, N = 168	female, N = 140
Age
Median (IQR)	70 (67, 75)	70 (67, 75)	71. (67, 76)
BMI
Median (IQR)	22.6 (20.5, 25.0)	22.3 (20.5, 24.4)	22.9 (20.3, 25.8)
ASA
Ⅱ	218 (70.8%)	123 (73.2%)	95 (67.9%)
Ⅲ	85 (27.6%)	40 (23.8%)	45 (32.1%)
Ⅳ	5 (1.6%)	5 (3.0%)	0 (0.0%)
Smoke
no	238 (77.3%)	99 (58.9%)	139 (99.3%)
yes	70 (22.7%)	69 (41.1%)	1 (0.7%)
Drink
no	242 (78.6%)	105 (62.5%)	137 (97.9%)
yes	66 (21.4%)	63 (37.5%)	3 (2.1%)
Education levels (years)
≤ 6	152 (49.4%)	61 (36.3%)	91 (65.0%)
6ཞ12	100 (32.5%)	66 (39.3%)	34 (24.3%)
>12	56 (18.2%)	41 (24.4%)	15 (10.7%)
Cognitive impairment
no	268 (87.0%)	149 (88.7%)	119 (85.0%)
yes	40 (13.0%)	19 (11.3%)	21 (15.0%)
Hypertension
no	201 (65.3%)	119 (70.8%)	82 (58.6%)
yes	107 (34.7%)	49 (29.2%)	58 (41.4%)
Coronary
no	288 (93.5%)	155 (92.3%)	133 (95.0%)
yes	20 (6.5%)	13 (7.7%)	7 (5.0%)
Cerebrovascular
no	297 (96.4%)	160 (95.2%)	137 (97.9%)
yes	11 (3.6%)	8 (4.8%)	3 (2.1%)
Diabetes
no	270 (87.7%)	151 (89.9%)	119 (85.0%)
yes	38 (12.3%)	17 (10.1%)	21 (15.0%)
COPD
no	293 (95.1%)	158 (94.0%)	135 (96.4%)
yes	15 (4.9%)	10 (6.0%)	5 (3.6%)
Preoperative Anxiety
no	220 (71.4%)	137 (81.5%)	83 (59.3%)
yes	88 (28.6%)	31 (18.5%)	57 (40.7%)
Frailty
no	246 (79.9%)	133 (79.2%)	113 (80.7%)
yes	62 (20.1%)	35 (20.8%)	27 (19.3%)
Sleep Disturbance
no	225 (73.1%)	124 (73.8%)	101 (72.1%)
yes	83 (26.9%)	44 (26.2%)	39 (27.9%)
Surgery Type
general	157 (51.0%)	100 (59.5%)	57 (40.7%)
orthopedics	96 (31.2%)	30 (17.9%)	66 (47.1%)
urinary	55 (17.9%)	38 (22.6%)	17 (12.1%)
Dexmedetomidine
no	193 (62.7%)	113 (67.3%)	80 (57.1%)
yes	115 (37.3%)	55 (32.7%)	60 (42.9%)
PNB
no	195 (63.3%)	107 (63.7%)	88 (62.9%)
yes	113 (36.7%)	61 (36.3%)	52 (37.1%)
Hypotension
no	80 (26.0%)	49 (29.2%)	31 (22.1%)
yes	228 (74.0%)	119 (70.8%)	109 (77.9%)
Surgery time
Median (IQR)	140 (91, 196)	155 (97, 219)	125 (90, 176)
Estimated Bleeding
Median (IQR)	50 (30, 150)	55 (30, 150)	50 (30, 163)
Fentanyl consumption
Median (IQR)	1.20 (0.30, 1.30)	1.20 (0.30, 1.60)	1.15 (0.30, 1.20)
Notes: Cognitive impairment was defined as the MMSE score of ≤ 20 with education ≤ 6, MMSE score of ≤ 24 with education>6. Anxiety was defined as the GAD-7 score>4. Frailty was defined as the FRAIL Score>2. Sleep Disturbance defined as the sleep-NRS score ≥ 6 Abbreviations: BMI, Body Mass Index; ASA, American Society of Anesthesiology; COPD, Chronic Obstructive Pulmonary Disease; PNB, Peripheral nerve block.

Incidence of Postoperative Anxiety

The overall incidence of POA was 51.9% (160 of 308 patients), with substantial variability observed among different surgical procedures. POA was most frequently observed after orthopedics surgery (64.6%), followed by urinary (60.0%) and general surgery (41.4%). Figure 1 illustrates the incidence of POA among all the enrolled patients. Notably, the prevalence of anxiety decreased over the initial 7 days post-surgery, with occurrences on days 1, 3, and 7 at 38.0%, 35.1%, and 17.2%, respectively (Fig. 2).

Comparisons of Outcomes Between the POA and non-POA Groups

Based on the occurrence of POA, we divided the patients into POA group and non-POA group. Clinical characteristics of the two groups showed significant differences in BMI, ASA score, preoperative anxiety, preoperative sleep disturbances, and surgery type (Supplement Table 2). Therefore, we adjusted for these variables when comparing postoperative outcomes between the two groups. Patients who developed POA exhibited significantly higher 24 h pain VAS scores and worsen PSQ scores on postoperative day 1, 2 and 3 than those patents without POA. Moreover, rescue analgesic (OR, 1.84; 95% CI, 1.09–3.11) and the anxiety on postoperative day 30 and 90 was elevated in patients with POA compared to those without POA. The odds ratio for the POA group was 2.22 (95% CI: 1.16 to 4.24) and 2.43 (95%CI: 1.23–4.80) compared to the non-POD group on postoperative day 30 and 90 (Table 2). However, the POD was not difference in two groups.

Table 2

Outcome analyses between postoperative anxiety and non-postoperative anxiety
Various	Unadjusted			Adjusted
Various	OR (95%CI)	Mean Difference (95% CI)	P	OR (95%CI)	LS Mean Difference (95% CI)	P
24 h Pain-VAS ^a		1.03 (0.66, 1.40)	< 0.001		0.88 (0.51, 1.25)	< 0.001
PSQ-1 ^a		0.88 ( 0.50, 1.25)	< 0.001		0.68 (0.30, 1.06)	< 0.001
PSQ-2 ^a		0.77 ( 0.41, 1.13)	< 0.001		0.65 (0.28, 1.02)	< 0.001
PSQ-3 ^a		0.57 ( 0.22, 0.91)	0.002		0.50 (0.14, 0.85)	0.007
Rescue analgesia ^b	1.48 (0.93, 2.35)		0.010	1.84 (1.09,3.11)		0.023
POD ^b	1.86 (0.83, 4.04)		0.130	1.72 (0.69, 4.29)		0.250
Axiety-30 ^b (n¹ = 287)	2.04 (1.15, 3.62)		0.015	2.22 (1.16, 4.24)		0.015
Anxiety-90 ^b (n¹ = 269)	2.02 (1.09, 3.76)		0.026	2.43 (1.23, 4.80)		0.011

Notes: ^aMean (Standard Deviation), ^bNumber (%), ¹There were 21 patients and 39 patients lost to follow-up, and ultimately 281 patients and 269 patients were included in the analysis for anxiety at postoperative day 30 and 90. Analysis were adjusted for BMI, ASA, Preoperative Anxiety, Sleep Disturbance, Surgery Type.

Abbreviations: POD: postoperative delirium, PSQ: postoperative sleep quality, VAS: Visual Analog Scale; CI, Confidential interval; OR, odds ratio; LS Least Squares.

Risk Factors for POA

According to the univariate logistic regression analysis, four distinct variables were linked to the occurrence of POA: BMI (OR, 1.08; 95% CI, 1.01–1.15), preoperative anxiety (OR, 4.36; 95% CI, 2.49–7.62), preoperative sleep disturbance (OR, 4.53; 95% CI, 2.54–8.05), and surgery type (general vs. orthopedics, OR, 0.39; 95% CI, 0.23–0.66) were associated with POA (Supplement Table 1). Multivariate logistic regression analysis in Fig. 3 indicated that preoperative anxiety (OR, 3.60; 95% CI, 1.76–7.40), preoperative sleep disturbance (OR, 3.34; 95% CI, 1.82–6.13) were significantly associated with the development of POA. Therefore, age and preoperative sleep disturbance were found to be independent risk factors for POA in this particular cohort.

Our analysis revealed a high incidence of POA in elderly patients, particularly those undergoing orthopedic (64.6%) and urological (60%) surgeries. This is consistent with prior research, which has indicated a significant occurrence of POA, albeit such studies have been relatively scarce. For example, a study by Caumo et al. evaluated 35 patients aged between 30 and 55 who underwent hysterectomy. They discovered that 76.9% of patients experiencing moderate to severe pain exhibited high state anxiety 24 hours postoperatively ²⁹. In our study, we observed a higher incidence of POA within the first seven days after surgery, which is understandable given our focus on elderly individuals. Due to the decline in physical function and the potential presence of chronic diseases in elderly patients, their susceptibility and vulnerability lead to a higher probability of perioperative complications ^30,31. The type of surgery appears to play a significant role in the occurrence of POA. Urological or orthopedic patients, who often experience varying degrees of preoperative dysfunction that can affect daily life, may worry about early postoperative function recovery. This could contribute to an increased incidence of POA.

Contrary to many existing studies, we found that the education level was not associated with POA. Matsumura et al. indicate that a lower education level was an independent risk factor for postpartum depression ³². In addition, among people in France without surgery, individuals with a lower level of education had a higher risk of anxiety-depressive state ³³. However, the focus of this study was to assess POA in elderly as well as the importance in elderly undergoing surgery. A new research conduct by Samudio-Cruz et. reveled that a higher education level reduces the risk of depression and anxiety, but their effect is less consistent in older adults after stroke, the education level with cognitive reserve may explain the results ³⁴. Indeed, the concept of cognitive reserve, often associated with higher education levels, suggests that individuals with more cognitive reserve have a greater ability to withstand brain pathology. This can result in a reduced risk of mental health conditions such as depression and anxiety. However, it could be the case that in older adults, the cognitive reserve is already functioning to counterbalance the alterations that come with normal aging ³⁵. This could potentially lead to the protective effect of a high level of education on mental disorders in older patients diminishing, or even becoming a harmful factor. Of course, this is a complex process that requires further research for a complete understanding.

Our study has found that patients who are more anxious in the preoperative showed an estimated 3.6 times higher risk of reporting POA. This result is in agreement with previous research ^3,6. However, due to the lack of systematic research evaluating POA, our results suggest that intervention in preoperative anxiety could potentially reduce the incidence of POA, thereby promoting patient recovery.

Our study identified that preoperative sleep disturbance was associated with a 3.34-fold increased risk of experiencing high POA. This aligns with research conducted by Kim et al., which also demonstrated that insomnia is associated with anxiety and depression ³⁶. The interplay between sleep and mood could be influenced by several factors, including immune response, neurogenesis, and metabolic processes ³⁷. Data from epidemiological studies propose that individuals suffering from insomnia tend to exhibit a higher prevalence of anxiety symptoms ³⁸. Similarly, those who are anxious are more prone to experience sleep problems ³⁹. Additionally, our study found that POA was significantly worsen the sleep quality on first three days postoperatively. It’s plausible that a cyclical relationship exists between sleep and anxiety ³⁷. The relationship between anxiety and sleep strongly suggests that it is necessary to both assess and if needed, improve the quality of sleep perioperatively.

POA can significantly exacerbate postoperative pain (median: 3.0 vs. 4.0). Numerous studies have established a close relationship between pain and perioperative anxiety. For instance, pain has been independently linked with anxiety in various types of surgery ^11,12,40. Pain directly triggers mood dysregulation, as evidenced by increased activity in the anterior cingulate gyrus (a brain region associated with mood regulation) when peripheral pain intensifies. Concurrently, anxiety and depression can heighten the perception of pain. This is due to the depletion of serotonin and norepinephrine found in depression and anxiety, which downregulates the pain-modulating serotonergic and noradrenergic neurons in the periaqueductal gray. This results in an amplification of minor pain signals from the body ⁴¹. These findings underscore the complex interplay between pain and anxiety in the perioperative period.

Indeed, there are significant limitations associated with the design of the study. As a retrospective observational study, it becomes challenging to establish causal relationships between risk factors and POA. In addition, the current study suffers from a small sample size and is derived from a single center, potentially limiting the reliability of the conclusions drawn in the research. Furthermore, we employed the GAD-7 to evaluate the incidence of perioperative anxiety in elderly patients. While GAD-7 has been validated as an effective tool for diagnosing anxiety within the Chinese population, the timing and frequency of assessments could potentially introduce a bias in the reported incidence of POA. These factors should be taken into consideration when interpreting the results of the study.

The results of the current study indicate that POA is linked with immediate postoperative outcomes, specifically pain and sleep. Additionally, POA was found to be associated with the development of anxiety after discharge. Several factors, including preoperative anxiety and preoperative sleep disturbance were identified as being associated with POA. However, due to the retrospective nature of this study, potential interactions might have remained undetected. We believe that this study lays a solid groundwork for future prospective clinical trials to determine whether standardized preoperative screenings and interventions for anxiety and sleep disturbance could be beneficial for elderly patients planning to undergo surgery, especially those at a high risk of POA.

Availability of data and materials

The analyzed data sets generated during the study are available from the corresponding author on reasonable request.

Acknowledgments

Not applicable.

Funding

This work was supported by the Special Fund of Neurotoxicity of General Anesthetics and Its Prevention and Treatment Innovation Team of the First Affiliated Hospital of Guangxi Medical University (No. YYZS2022001); Guangxi Clinical Research Center for Anesthesiology (No. GK AD22035214); the Key Project of Natural Science Foundation of Guangxi (No. 2020GXNSFDA238025).

Author information

Authors and Affiliations

Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.

Hao Guo, Li-Heng Li, Yu-Bo Xie

Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University.

Xiao-Hong Lv

Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.

Fei Xiao

Contributions

HG contributed to the conception and design of the study, reviewed and analyzed the data and wrote the manuscript. LHL and XHL reviewed and analyzed the data and wrote the manuscript. FX contributed guided the research and revised the manuscript. YBX conceived and designed the study, and revised the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding authors

Correspondence to Yu-Bo Xie

Ethics declarations

Ethics approval and consent to participate

The study protocol (ethical number: 2019 KEY-E-115) obtained approval from the Ethics Committee of the First Affiliated Hospital of Guangxi Medical University. Because of retrospective study, informed consent was waived.

Consent for publication

Not applicable.

Competing interests

The authors declare they have no competing interests.

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Incidence, Associated Risk Factors, and Outcomes of Postoperative Anxiety in Elderly: a retrospective study

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Abstract

Background

Methods

Results

Conclusion

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Background

Methods

Study design and patient selection

Data Collection Protocol

Preoperative and Intraoperative Data

Postoperative Follow-Up Data

Anxiety status evaluation

Statistical Analysis

Results

Demographic and Intro-operative Data

Incidence of Postoperative Anxiety

Comparisons of Outcomes Between the POA and non-POA Groups

Risk Factors for POA

Discussion

Conclusion

Declarations

References

Additional Declarations

Supplementary Files

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