A Prospective Study to Explore Pain, Anxiety, and Acute Confusion in Patients With Abdominal Surgery

Purpose:  Abdominal surgery is a very stressful process for patients. Pain, anxiety and acute confusion were common complication during surgery. Unfortunately, Acute confusion adverse outcomes, including longer hospital stay, and higher mortality. In Taiwan, most studies utilized a cross-sectional study design to respectively explore pain, anxiety and acute confusion in patients with surgery. Former studies lack of focus on trends of pain and acute confusion as well as predictors of acute confusion during pre-post operation. Therefore, this study were designed to search trends and predictor of pain, anxiety and acute confusion at pre-operative period(T1), 24 hours within post-operation (T2), and 72 hours after post-operation.

Methods:

A prospective, observational, repeated-measure, correlational design was adopted. From August 2014 to May 2015, there were 60 patients with abdominal surgery who admitted to intensive care unit were recruited from a medical center in the northern Taiwan. Inclusion criteria were patients aged twenty and above, and with a Richmond Agitation Sedation Scale score between -3 and +4. This study assessment of acute confusion using confusion assessment method for the ICU (CAM-ICU), and Pain assessment using the critical-care pain observation tool in Chinese, and anxiety measurement tool using heart rate variability.

Results:

Using generalized estimating equation analysis, results showed that the change of pain and acute confusion were significantly different over the three time points. The highest pain score was at T2, and then it decreased at T3, and also predicting acute confusion. The highest incidence was at T2, and then increased as time passed by. The change in anxiety through the pre-post operation was not significantly different. The different domains of heart rate variation were all with downward trends at T2, and then followed upward curves at T3.

Conclusion:  Results of this study help to understand the change of pain, anxiety and acute confusion over the pre-post operation period, and pain level and anxiety were predictors of acute confusion in patients with abdominal surgery. Recommendations from this study results are (1) to include the acute confusion assessment within the routine nursing care, and (2) to monitor predictors of acute confusion in patients with abdominal surgery during their pre-post operation period.