De rol van preoperatieve angst bij de ontwikkeling van postoperatief delier bij oudere chirurgische patiënten

The overall aim of my PhD study is to assess the role of preoperative anxiety in the development of postoperative delirium (POD) in older surgical patients by reviewing the literature; and by developing, finetuning and evaluating an intervention to reduce preoperative anxiety and the incidence of POD. POD is an adverse complication that manifests as acute and fluctuating alterations of mental status, involving disturbances in attention, consciousness, and cognition. The incidence of POD among older patients undergoing cardiac and major noncardiac surgery is reported to be as high as 60%, and POD leads to multiple adverse outcomes, including higher morbidity and mortality, an increase in the duration of hospitalization, and higher rates of readmission and functional decline, as well as increased levels of dependency in activities of daily living post-discharge. It is estimated that 25%-80% of patients admitted to the hospital for surgery experience preoperative anxiety, and anxiety can negatively influence patient recovery. However, data on preoperative anxiety and its relationship with POD, especially in older patients, are scarce. Only few studies have explored this relationship, with most of them showing inconclusive results due to methodological problems (e.g. small sample sizes and conceptual issues with regard to the evaluation of preoperative anxiety and POD). Hence, more rigorous research targeting the role of preoperative anxiety in the development of POD in older surgical patients is needed, as well as the development and evaluation of preoperative anxiety reducing interventions and their effects on POD.