Prevalência da ansiedade pré-operatória em pacientes anestésico-cirúrgicos: revisão sistemática e metanálise

Abstract

Background: In recent years, preoperative anxiety has been increasing, despite the technological development and medical interference it presents high rates. Related to different factors involving the anesthetic-surgical process, anxiety, when manifested, may cause anesthetic and hemodynamic changes during induction, and may be identified in the postoperative period. Objective: To determine the overall prevalence of preoperative anxiety in anesthetic-surgical patients. Method: Systematic review with meta-analysis, using as search strategy the following databases: MEDLINE, LILACS and EMBASE. Articles published in any language from 1999 to 2020 were included. It was conducted according to the Joanna Briggs Institute (JBI) methodology, recommended for critical appraisal, study selection, data extraction and synthesis, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, used to assess the quality of evidence. Searches were conducted on July 6, 2020. Observational studies that reported prevalence data of preoperative anxiety in anesthetic-surgical patients were included. The estimate of overall anxiety prevalence was established with the significance level at p ≤ 0.05 with 95% confidence interval (CI), considering anxiety levels as a subgroup. The heterogeneity between studies using inferential statistics with the (I²) test, and meta-analysis by the Freeman-Tukey method. Results: The search returned 1,631 studies and 67 met the inclusion criteria. The overall prevalence of preoperative anxiety was 62.4% (95% confidence interval [CI], 50.00-74.00; I² = 100%, low-quality evidence), the subgroups formed by the levels of anxiety varied among studies and the estimates were: mild 34.64% (98% CI: 27.77-41.84), moderate 10.11% (99% CI: 4.36-17.76) and severe 28.75% (98% CI: 22.46-35.47). Conclusion: The study evidenced that patients' preoperative anxiety is high. Consequently, anxiety symptoms generate changes that affect anesthesia and hemodynamics. The main conditioning factors are associated with research for anxiety and more effective communication. Therefore, it is important to invest in better understanding of clinical investigations of preoperative anxiety, with systematized protocols and approach. PROSPERO Registration, under protocol CRD420200871.