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

Table 1 Baseline demographic and clinical characteristics, n (%)

Characteristic	Total (n = 120)	General anesthesia (n = 58)	Spinal anesthesia (n = 62)	P value
Age (years), mean ± SD	62.4 ± 11.3	61.8 ± 12.1	63.0 ± 10.6	0.56
Male sex	78 (65.0)	38 (65.5)	40 (64.5)	0.91
BMI (kg/m2), mean ± SD	26.8 ± 4.2	27.1 ± 4.5	26.5 ± 3.9	0.43
ASA classification				0.68
I	28 (23.3)	14 (24.1)	14 (22.6)
II	68 (56.7)	31 (53.4)	37 (59.7)
III	24 (20.0)	13 (22.4)	11 (17.7)
Procedure type				0.82
TURP	68 (56.7)	32 (55.2)	36 (58.1)
TURBT	42 (35.0)	21 (36.2)	21 (33.9)
Other	10 (8.3)	5 (8.6)	5 (8.1)
Previous surgery	45 (37.5)	22 (37.9)	23 (37.1)	0.92
Comorbidities
Hypertension	52 (43.3)	25 (43.1)	27 (43.5)	0.96
Diabetes	31 (25.8)	15 (25.9)	16 (25.8)	0.99
Cardiac disease	18 (15.0)	9 (15.5)	9 (14.5)	0.88

Previous surgery refers to any prior surgical procedure documented in the medical record. BMI: Body mass index; ASA: American Society of Anesthesiologists; TURP: Transurethral resection of the prostate; TURBT: Transurethral resection of bladder tumor.

Table 2 Psychological outcomes by anesthetic technique, mean ± SD

Outcome	General anesthesia	Spinal anesthesia	Mean difference (95%CI)	P value
STAI-state scores
Baseline	49.2 ± 14.5	48.1 ± 14.0	1.1 (-4.0 to 6.2)	0.67
Preoperative	52.8 ± 15.2	46.3 ± 13.8	6.5 (1.3-11.7)	0.02
POD 1	41.1 ± 12.3	35.8 ± 11.6	5.3 (0.9-9.7)	0.02
POD 7	36.4 ± 10.8	33.9 ± 10.2	2.5 (-1.3 to 6.3)	0.20
BDI-II scores
Baseline	13.2 ± 9.7	12.4 ± 9.2	0.8 (-2.6 to 4.2)	0.64
POD 7	11.8 ± 8.9	10.2 ± 8.3	1.6 (-1.5 to 4.7)	0.31
POD 30	10.4 ± 8.2	8.9 ± 7.6	1.5 (-1.3 to 4.3)	0.30

Baseline assessments were performed 24 hours before surgery, and preoperative assessments were conducted in the holding area immediately before anesthesia induction. Mean differences are calculated as values in the general anesthesia group minus those in the spinal anesthesia group. CI: Confidence interval; STAI: State-Trait Anxiety Inventory; POD: Postoperative day; BDI: Beck Depression Inventory.

Table 3 Postoperative complications by baseline anxiety level, n (%)

Complication	Low anxiety (n = 38)	Moderate anxiety (n = 31)	Severe anxiety (n = 51)	P value
Any complication	6 (15.8)	9 (29.0)	17 (33.3)	0.04
Clavien-Dindo grade				0.02
Grade I	4 (10.5)	5 (16.1)	9 (17.6)
Grade II	2 (5.3)	3 (9.7)	6 (11.8)
Urinary retention	2 (5.3)	4 (12.9)	9 (17.6)	0.04
Bleeding requiring transfusion	1 (2.6)	2 (6.5)	3 (5.9)	0.68
UTI	2 (5.3)	3 (9.7)	5 (9.8)	0.71
Readmission within 30 days	1 (2.6)	2 (6.5)	4 (7.8)	0.58

Anxiety severity was categorized based on State-Trait Anxiety Inventory-state scores as follows: Low anxiety (20-39), moderate anxiety (40-54), and severe anxiety (≥ 55). Postoperative complications were graded according to the Clavien-Dindo classification. UTI: Urinary tract infection.