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GENERAL ARTICLES

Does Measurement of Preoperative Anxiety Have Added Value for Predicting Postoperative Nausea and Vomiting?

Jolanda E. Van den Bosch, MSc, Karel G. Moons, PhD^*, Gouke J. Bonsel, PhD, and Cor J. Kalkman, MD, PhD^*

*Department of Perioperative Care and Emergency Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; and Department of Public Health, University Medical Center Amsterdam, Amsterdam, The Netherlands

Address correspondence and reprint requests to Cor J. Kalkman, MD, PhD, Department of Perioperative Care and Emergency Medicine, University Medical Center Utrecht, Mail-Stop E. 03.511, PO Box 85500, 3508 GA Utrecht, The Netherlands. Address e-mail to c.j.kalkman{at}azu.nl.

Preoperative anxiety has been suggested as a predictor of postoperative nausea and vomiting (PONV), but supporting data are lacking. We quantified the added predictive value of preoperative anxiety to established predictors of PONV in 1389 surgical inpatients undergoing various procedures, by using multivariate logistic regression analysis. Investigated predictors were a history of PONV or motion sickness, smoking, sex, age, ethnicity, body mass index, ASA physical status, surgery type, duration of anesthesia, anesthetic technique, and postoperative opioid analgesia. Anxiety was measured by the Spielberger State-Trait Anxiety Inventory and the Amsterdam Preoperative Anxiety and Information Scale. The outcome was the occurrence of PONV in the first 24 h after surgery. The area under the receiver operating characteristic curve of a multivariate (logistic regression) model including sex, age, smoking, history of PONV or motion sickness, surgery type, and anesthetic technique was 0.72 (95% confidence interval, 0.70–0.74). There was a weak but significant association of anxiety with PONV, but the addition of anxiety to the model did not further increase the area under the receiver operating characteristic curve. Therefore, routine preoperative measurement of anxiety does not seem warranted, provided that the other predictors are already considered.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999