Dissertation committee:
Ζωγράφος Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλμπανόπουλος Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Μενενάκος Ευάγγελος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεοδώρου Δημήτριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τούτουζας Κωνσταντίνος Γ., Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Αλεξάκης Νικόλαος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεοδωρόπουλος Γεώργιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: The prevalence of obese individuals with a BMI ≥ 30 Kg / m² has become a global health problem associated with the increasing prevalence of comorbidities. Surgical treatment is the only effective and long-term treatment solution to reduce body weight and improve concomitant diseases. Ineffective treatment of postoperative pain has been associated with postoperative complications and prolonged hospitalization of surgical patients, with bariatric patients at greater risk for diseases of the respiratory and circulatory systems. The identification of preoperative factors that affect the postoperative pain of bariatric patients can significantly contribute to the design of a more effective postoperative analgesia protocol, contributing to the smooth postoperative course without complications.
Aim: To investigate the possible relationship between psychological factors "stress" and "depression" and the dimensions of the personality of obese patients, with the postoperative pain of the first 24 hours, after bariatric surgery. The ultimate goal of the research was to contribute to the possible introduction of preoperative assessment of patients' mental health and personality and possible redefinition of the postoperative analgesia protocol, taking into account the individualized psychological and personality needs of bariatric patients.
Material and method: The study included 100 obese patients with a mean Body Mass Index (BMI) of 47.6 Kg / m², of whom 58 underwent Laparoscopic Sleeve Gastrectomy (LSG) and 42 underwent Laparoscopic One-Anastomosis Gastric ByPass (LOAGB) with a predetermined protocol of intraoperative and postoperative analgesia. Preoperative assessment of patients' mental health (anxiety, depression) was performed with the "Hospital Anxiety and Depression Scale" (HADS) and personality (psychoticism, neuroticism, extroversion, lying) with the questionnaire "Personality Questionnaire EYSENCK". Postoperative pain was recorded in "quantitative" and "qualitative" dimensions with the Mc Gill Pain Questionnaire (SF-MPQ), which includes the Numerical Rating Scale (NRS) to record the quantitative dimension of pain and the scale of present pain intensity (Present Pain Index - PPI) and for the recording of the qualitative dimension of pain includes the scale of sensory (SENSORY) and emotional (AFFECTIVE) dimension as well as the scale of a total score of sensory and emotional dimension (TOT SFMPQ). The recordings were made at the 1st, 4th, 8th, 12th, 24th postoperative hour (POP ≠ 0), and the statistical program SPSS 25.0 was used for data analysis.
Results: On the NRS scale at the 1st hour, anxiety was statistically significantly correlated with pain (b = 0.13, p <.05) while the lie scale was negative (b = -0.13, p <.05), at the 4th hour depression was statistically significantly correlated with pain (b = 0.19, p <.05), at the 8th hour depression was statistically significantly correlated with pain (b = 0.19, p <.05) and at 24th hour, psychosis was correlated statistically significant negative with pain (b = -0.18, p <.05). Regarding the PPI scale, at the 1st hour, the lie scale was statistically significantly correlated negatively with pain (b = -0.10, p <.01), at the 4th hour depression was statistically significantly positively correlated with pain (b = 0.11, p <.001) while the lie scale was negative (b = -0.07, p <.05) and at the 8th hour depression was statistically significantly positively associated with pain (b = 0.07, p <.01). Regarding the SFMPQ-TOTAL scale, during the 1st hour, depression was statistically significantly positively associated with pain (b = 0.83, p <.01) while the lie scale was negatively correlated (b = -0.71, p <.01), at the 4th hour depression was statistically significantly positively correlated with pain (b = 0.85, p <.001) while the lie scale was negative (b = -0.50, p <.01), at the 8th hour depression was associated with statistically significant positive with pain (b = 0.84, p <.01) while the lie scale was negative (b = -0.62, p <.01) and at the 12th hour the lie scale was statistically significantly negatively associated with pain (b = -0.30, p <.05).
Conclusions: Increased levels of preoperative anxiety and depression in patients increase postoperative pain scores. More specifically, increased stress increases the pain score in intensity (1st hour), and increased depression also increases the pain score in intensity but also in sensory/emotional level (1st, 4th, 8th hour) after surgery. In contrast, the effect of psychosis and lying on postoperative pain is different, with increased rates of psychosis and lying affecting the reduction of pain scores. As psychosis increases, the pain in the quantitative dimension of pain of 24 hours decreases, and as the lie increases, the pain decreases in the quantitative (1st hour) and qualitative (1st, 4th, 8th, 12th hour) dimension of pain. The results of research on the effect of preoperative anxiety and depression on postoperative pain are consistent with previous studies and extend the knowledge to qualitative analysis of bariatric patients' pain but it is necessary to research the effect of personality factors such as psychosis and lying for replicability of the present study’s research results. The determination of mental health and personality before the surgical treatment contributes to the individualized and, therefore, more effective treatment of pain, after bariatric surgery.
Keywords:
Obesity, Bariatric surgery, Pain dimensions, Postoperative pain, Preoperative anxiety, Preoperative depression, Mental health of obese, Obese personality
