O impacto da avaliação pré-anestésica na ansiedade dos pacientes ortopédicos: um ensaio clpinico randomizado

Abstract

Reference: The Impact of Pre-anesthetic Evaluation on Anxiety in Orthopedic Patients: A Randomized Clinical Trial. Background: Pre-anesthetic evaluation (PAE) is an essential process that prepares patients for surgery and may reduce anxiety and associated risks. It is a patient right and a medical duty, according to the resolutions of the Federal Council of Medicine (CFM). The relationship between PAE and anxiety reduction still requires robust evidence in the Brazilian scenario, a gap this study seeks to fill within the context of orthopedic trauma. Objective: To evaluate the impact of PAE timing on perioperative anxiety levels in patients undergoing orthopedic surgery. Secondary objectives included performing a concurrent validation of the Likert scale (self-declaration) against the short-form STAI scale and determining the prevalence of clinically significant anxiety in the sample compared to data available in national and international literature. Method: A randomized clinical trial was conducted with inpatients for orthopedic surgery at a tertiary hospital. Patients with a previous diagnosis of anxiety or depression disorders were excluded. Participants were allocated into two groups: Group 1 Control (PAE a few minutes before surgery) or Group 2 Intervention (PAE up to 12 hours before the surgical procedure). Anxiety was measured upon admission to the preoperative room using the short-form STAI scale and a Likert scale. Results: A total of 99 patients were analyzed, predominantly male (72%), lowincome (58%), and accident victims (75%). The mean short-form STAI score was 20.6 (moderate anxiety). The Likert scale was validated against the short-form STAI, showing a discriminative accuracy of 0.914. An anxiety prevalence of 24.2% was identified, a value lower than global averages, potentially influenced by the sample's resilience profile and the exclusion criteria. There was no statistically significant difference in global scores between groups; however, the variable "I am tense" showed a significant reduction in the intervention group (p=0.023). Discussion: The results indicate that the timing of the evaluation did not alter global anxiety scores, diverging from part of the international literature. However, the specific reduction in tension suggests that early PAE modulates extreme emotional states. The low prevalence found reflects the intrinsic characteristics of the treated trauma population and the impact of excluding patients with a psychiatric history from the sample. Conclusion: PAE does not suppress basal anxiety, a legitimate emotional response, but it modulates its most extreme peaks, such as tension. The validation of the Likert scale as a rapid screening tool demonstrates practical utility for clinical workflow. The equivalence between groups validates the logistic flexibility of the service in public hospitals, allowing for schedule organization according to demand without compromising the measured emotional well-being.