Perioperative anxiety and depression in patients undergoing transurethral urological surgeries: The role of anesthetic management

Abstract

BACKGROUND

Perioperative anxiety and depression are common, yet often underestimated psychological comorbidities in patients undergoing transurethral urological surgery. These emotional disturbances can negatively affect anesthesia induction, hemodynamic stability, postoperative pain, and recovery. The choice of anesthetic technique and adjunctive psychological intervention may have influenced these outcomes.

AIM

To evaluate the prevalence and clinical impact of perioperative anxiety and depression in patients undergoing transurethral surgeries and compare the effectiveness of different anesthetic and psychological management strategies.

METHODS

A retrospective observational analysis was conducted in 120 patients who underwent transurethral resection between January 2022 and December 2023. Preoperative anxiety and depression were assessed using the State-Trait Anxiety Inventory (STAI) and Beck Depression Inventory-II. Patients receiving general anesthesia or spinal anesthesia (SA) were compared and subgroup analyses were performed to examine the effects of pharmacological interventions (dexmedetomidine vs midazolam) and nonpharmacological methods (music therapy and structured education). The primary outcomes were perioperative changes in STAI and Beck Depression Inventory-II scores, and the secondary outcomes included hemodynamic stability, postoperative complications, pain control, and recovery parameters.

RESULTS

Preoperative anxiety and depression were present in 68.3% and 35.8% of the patients, respectively. SA significantly reduced postoperative anxiety compared with general anesthesia (ΔSTAI -12.3 ± 8.4 vs -8.1 ± 7.2; mean difference -4.2;P = 0.004) and was associated with better intraoperative hemodynamic stability. Dexmedetomidine provided superior anxiolysis and reduced postoperative delirium (6.7% vs 20.0%; risk difference -13.3%; P = 0.02), although mild bradycardia occurred more frequently (16.7% vs 3.3%). Music therapy and structured preoperative education effectively reduced anxiety and improved patient satisfaction (P < 0.001). Patients with moderate to severe preoperative anxiety exhibited higher postoperative complication rates (32.5% vs 15.3%; risk difference +17.2%; P = 0.008) and longer hospital stays (3.8 ± 1.6 days vs 2.9 ± 1.1 days; P = 0.002). Persistent depressive symptoms were observed in 23.3% of the patients at 30 days.

CONCLUSION

Perioperative anxiety and depression are highly prevalent in patients undergoing transurethral urological surgery and are associated with worse postoperative outcomes. SA, dexmedetomidine, music therapy, and structured education are associated with better psychological stability and clinical recovery. Integrating routine screening and multimodal psychological management appears beneficial in perioperative care.

Keywords: Transurethral surgery; Perioperative anxiety; Depression; Anesthetic management; Dexmedetomidine; Music therapy; Spinal anesthesia; Retrospective study

Core Tip: This study highlights the high prevalence of perioperative anxiety and depression among patients undergoing transurethral urological surgery and their significant impact on postoperative outcomes. In this retrospective analysis of 120 cases, spinal anesthesia combined with music therapy and structured education effectively reduced anxiety and improved satisfaction. Dexmedetomidine demonstrated superior anxiolytic effects compared with midazolam, with fewer postoperative complications. These findings emphasize the need for routine psychological screening and multimodal management that integrates anesthetic, pharmacological, and psychological strategies to enhance recovery and overall patient well-being.