Impact of stress and preoperative psychological preparation on immunity, inflammatory responses, and surgical outcomes in adults undergoing elective surgery with general anesthesia in Palestine

Stress is a normal human physiological reaction that can unfavorably affect the body, such as cardiac and immunological disturbances. Several articles have shown how stress can affect the immune status. This study was designed to assess the impact of stress on the immune system using the WBC count as an indicator of immune status in the human body. In a tertiary care teaching hospital, a prospective observational study was carried out with a total of 309 samples collected; two complete blood counts were observed for each patient, one at the anesthesia clinic one week before the surgery and the other on the day of the surgery immediately following the beginning of the surgery; and each patient answered a Hospital Anxiety Depression Scale form just before presenting to the operating room for stress level assessment. Representative serum samples from patients with and without anxiety were assessed for proinflammatory and anti-inflammatory profiles via ELISA. In our study of 309 patients, 31.4% experienced stress, with the majority being females. Age did not significantly impact stress levels, but preoperative preparation and information gathering were significantly related to stress (P value.05), as the mean stress was highest among those using online searching as their primary source of information. The difference in immune mediators (WBCs, lymphocytes, and neutrophils) before and on the day of surgery was correlated with stress, with WBCs and lymphocytes showing a statistically significant decrease in P values (0.019, 0.016). In contrast, neutrophils increased acutely (P value.006). A total of 71.4% of patients suffering from postoperative complications were stressed before the procedures, with a strong association (P value of 0.003). In addition, the levels of the proinflammatory cytokines IL-1b, IL-6, TNF-a, and IL-2 were significantly increased by 4-, 10-, 2-, and 3-fold, respectively, in the sera of participants who were anxious compared with those who had no anxiety. Stress is associated with decreased WBCs and lymphocytes, and increased neutrophils. Therefore, stress should be considered a modifiable preoperative risk factor. Incorporating psychological assessments in anesthesia clinics may help identify and manage patients with high anxiety. The use of anxiolytics could be considered in selected cases, pending further evaluation of evidence.