Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-08T17:33:13.125Z Has data issue: false hasContentIssue false
  • English
  • Français

Detection of causal relationships between factors influencing adverse side-effects from anaesthesia and convalescence following surgery: a path analytical approach

Published online by Cambridge University Press:  23 December 2004

M. Reuter ,
M. Hueppe ,
K. F. Klotz ,
M. Beckhoff ,
J. Hennig ,
P. Netter  and
P. Schmucker
M. Reuter
Affiliation:
University of Giessen, Department of Psychology, Giessen, Germany
M. Hueppe
Affiliation:
Medical University of Lübeck, Department of Anaesthesiology, Lübeck, Germany
K. F. Klotz
Affiliation:
Medical University of Lübeck, Department of Anaesthesiology, Lübeck, Germany
M. Beckhoff
Affiliation:
Medical University of Lübeck, Department of Anaesthesiology, Lübeck, Germany
J. Hennig
Affiliation:
University of Giessen, Department of Psychology, Giessen, Germany
P. Netter
Affiliation:
University of Giessen, Department of Psychology, Giessen, Germany
P. Schmucker
Affiliation:
Medical University of Lübeck, Department of Anaesthesiology, Lübeck, Germany
Get access

Abstract

Summary

Background and objective: The anaesthesiologist's preoperative interview with the patient is important in preparing the patient for surgery. Its potential protective influence on adverse side-effects from anaesthesia and convalescence is rarely investigated within the context of other perioperative factors. Structural equation modelling allows detection and quantification of all causal relationships and mediator effects in multivariate models. Therefore, this method is presented as a tool and applied to discover the influence of the preoperative interview within socio-demographic variables and duration of surgery on complaints and recovery after anaesthesia.

Methods: The influence of individual satisfaction with the anaesthesiologist's preoperative interview on postoperative events such as nausea/vomiting, difficulties in recovering from anaesthesia, experience of postoperative pain, physical discomfort and satisfaction with convalescence expressed by the patient was analysed by means of structural equation modelling. The variables gender, age and duration of surgery were also included as predictors in the analyses. The model in the total sample of 710 patients was then analysed for structural differences between groups treated either with propofol (n = 204) or with isoflurane + nitrous oxide (n = 267) for maintenance of anaesthesia.

Results: The model revealed that the anaesthesiologist's preoperative interview in combination with associated mediating side-effects explains 45% of the variance of ‘feeling physical discomfort’ and 18% of the variance of ‘satisfaction with convalescence’. The same model could be fitted in the propofol and the isoflurane + nitrous oxide group. Moreover, the structure and the strength of causal relations between variables were identical in the two groups.

Conclusions: The anaesthesiologist's efforts to improve the interview with the patient by more reassuring and proper information will result in less side-effects from anaesthesia and better recovery from surgery. It could be demonstrated that structural equation modelling is a powerful tool for detection of causal relationships and mediator effects in perioperative medicine.

Keywords

ANAESTHESIAANAESTHETICS, INHALATIONAL, isoflurane, nitrous oxideANAESTHETICS, INTRAVENOUS, propofolDATA COLLECTION, interviewsPATIENT SATISFACTIONSURGICAL PROCEDURES, OPERATIVE, preoperative care
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 6 , June 2004 , pp. 434 - 442
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Shalev AY, Schreiber S, Galai T, Melmed RN. Post traumatic stress disorder following medical events. Br J Clin Psychol 1993; 32: 247–253.Google Scholar
Schreiber S, Galai-Gat T. Uncontrolled pain following physical injury as the core-trauma in the post-traumatic stress disorder. Pain 1993; 54: 107–110.Google Scholar
Udelsman R, Chrousos GP. Hormonal responses to surgical stress. In: Chrousos GP, Loriaux DL, GOLD PW, eds. Mechanisms of Physical and Emotional Stress. Advances in Experimental Medicine and Biology, Vol. 245. New York, USA: Plenum Press, 1988: 265–272.
Brodner G, Van Aken H, Hertle L, et al. Multimodal perioperative management – combining thoracic epidural analgesia, forced mobilization, and oral nutrition – reduces hormonal and metabolic stress and improves convalescence after major urologic surgery. Anest Analg 2001; 92: 1594–1600.Google Scholar
Bolton V, Brittain M. Patient information provision: its effect on patient anxiety and the role of health information services and libraries. Health Libr Rev 1994; 11: 117–132.Google Scholar
Shuldham C. A review of the impact of pre-operative education on recovery from surgery. Int J Nurs Stud 1999; 36: 171–177.Google Scholar
Hoyle RH, Panter A. Writing about structural equation models. In: Hoyle RH, ed. Structural Equation Modeling, Concepts, Issues and Applications. Thousand Oaks, USA: Sage, 1995: 158–176.
Hoyle RH. The structural equation modeling approach, basic concepts and fundamental issues. In: Hoyle RH, ed. Structural Equation Modeling, Concepts, Issues and Applications. Thousand Oaks, USA: Sage, 1995: 1–15.
Kain ZN, Sevarino F, Alexander GM, Pincus S, Mayes LC. Preoperative anxiety and postoperative pain in women undergoing hysterectomy. A repeated-measures design. J Psychosom Res 2000; 49: 417–422.Google Scholar
Rhoton MF, Barnes A, Flashburg M, Ronai A, Springman S. Influence of anaesthesiology residents' noncognitive skills on the occurrence of critical incidents and the residents' overall clinical performances. Acad Med 1991; 66: 359–361.Google Scholar
Hüppe M, Klotz KF, Heinzinger M, Prussmann M, Schmucker P. Rating the perioperative period by patients. First evaluation of a new questionnaire. Anaesthesist 2000; 49: 613–623.Google Scholar
Muthén B. A general structural equation model with dichotomous, ordered categorical and continuous latent variable indicators. Psychometrka 1984; 49: 115–132.Google Scholar
Bollen KA. Categorial observed variables. In: Bollen KA, ed. Structural Equations with Latent Variables. New York, USA: Wiley, 1989: 433–448.
Kline RB. Principles and Practice of Structural Equation Modeling. New York, USA: Guilford Press, 1998.
Jöreskog KG. Testing structural equations models. In: Bollen KA, Long SJ, eds. Testing Structural Equations Models. Newbury Park, USA: Sage, 1993: 295–316.
Jöreskog KG, Sörbom D. LISREL 8.51. Lincolnwood, USA: Scientific Software International, 2001.Google Scholar
Apfel CC, Roewer N. Risk factors for nausea and vomiting after general anaesthesia: fictions and facts. Anaesthesist 2000; 49: 629–642.Google Scholar
Visser K, Hassink EA, Bonsel GJ, Moen J, Kalkman CJ. Randomized controlled trial of total intravenous anaesthesia with propofol versus inhalation anaesthesia with isoflurane- nitrous oxid: postoperative nausea with vomiting and economic analysis. Anesthesiology 2001; 95: 616–626.Google Scholar
Ozkose Z, Ercan B, Unal Y, et al. Inhalation versus total intravenous anaesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost. J Neurosurg Anesthesiol 2001; 13: 296–302Google Scholar