The Effects of Preoperative Anxiety Level in Patients with Nasogastric Tube Inserted on Postoperative Quality of Recovery and Pain undergoing Laparoscopic Cholecystectomy under General  Anesthesia

Background: Nasogastric tube inserted before laparoscopic cholecystectomy is a preoperative common preparation, which is an invasive procedure and exacerbates the patient’s anxiety level. This prospective, observational, cohort study aimed to explore the effects of preoperative anxiety level in patients with nasogastric tube inserted on the postoperative quality of recovery and pain undergoing laparoscopic cholecystectomy, and analyze the correlation between preoperative anxiety level and the postoperative quality of recovery. Method: Patients with STAI-S＞40 were excluded the day before surgery. After entering the operating room, patients were assessed anxiety level using the Anxiety - Visual Analog Scale. The quality of recovery was assessed using 15 - items quality of recovery on postoperative day 1 and 2. The pain was evaluated with the Numerical Rating Scale. 17 cases were excluded, and a total of 80 patients were enrolled in this study. Results: : Compared with the group N, Anxiety Visual Analog Scale scores were higher in the group Y (with nasogastric tube inserted) after entering the operating room ( P < 0.001), 15 - items quality of recovery scores on postoperative day 1 in the group Y was lower than group N (without nasogastric tube inserted) ( P < 0.001). Pain intensity was higher in group Y at 2, 4, 8, 12, 24 and 48h after surgery than in Group N ( P < 0.050). Anxiety Visual Analog Scale scores were significantly and negatively correlated with the 15- items quality of recovery scores (r = -0.91, P < 0.001). Compared with group N, group Y had longer time to get out of bed and postoperative first flatus time ( P < 0.001). The AIS scores were higher on the night after surgery in group Y than in group ( P < 0.001). Conclusion: In summary, nasogastric tube inserted increases preoperative anxiety level, which is associated with lower postoperative quality of recovery and higher pain intensity after surgery, and affects the patient's emergence time and postoperative sleep quality. We can implement intervention measures according to patients' conditions to relieve patients' preoperative anxiety level, improve the postoperative quality of recovery, improve patients' satisfaction and speed up recovery. Trial registration: This prospective, observational, cohort study selected patients who underwent laparoscopic cholecystectomy at Xuzhou Central Hospital from April 2022 to June 2022. The study was approved by the Ethics Committee of Xuzhou Central Hospital (XZXY-LK-20220318-024) and registered on Clinicaltrials.gov (10/04/2022, ChiCTR2200058548).