The brief measure of preoperative emotional stress screens preoperative maladaptive psychological features and predicts postoperative opioid use: an observational study
A breve medida do estresse emocional pré-operatório rastreia características psicológicas desadaptativas pré-operatórias e prediz o uso de opioides no pós-operatório: um estudo observacional
Rogério Boff Borges, Wolnei Caumo, Caroline Bavaresco, Luciana Paula Cadore Stefani, Vinicius Souza dos Santos, Stela Maris de Jezus Castro
Abstract
Background
The Brief Measure of Preoperative Emotional Stress (B-MEPS) is a suitable screening tool for Preoperative Emotional Stress (PES). However, personalized decision-making demands practical interpretation of the refined version of B-MEPS. Thus, we propose and validate cut-off points on the B-MEPS to classify PES. Also, we assessed if the cut-off points screened preoperative maladaptive psychological features and predicted postoperative opioid use.
Methods
This observational study comprises samples of two other primary studies, with 1009 and 233 individuals, respectively. The latent class analysis derived emotional stress subgroups using B-MEPS items. We compared membership with the B-MEPS score through the Youden index. Concurrent criterion validity of the cut-off points was performed with the severity of preoperative depressive symptoms, pain catastrophizing, central sensitization, and sleep quality. Predictive criterion validity was performed with opioid use after surgery.
Results
We chose a model with three classes labeled mild, moderate, and severe. The Youden index points -0.1663 and 0.7614 of the B-MEPS score classify individuals, in the severe class, with a sensitivity of 85.7% (80.1%–90.3%) and specificity of 93.5% (91.5–95.1%). The cut-off points of the B-MEPS score have satisfactory concurrent and predictive criterion validity.
Conclusions
These findings showed that the preoperative emotional stress index on the B-MEPS offers suitable sensitivity and specificity for discriminating the severity of preoperative psychological stress. They provide a simple tool to identify patients prone to severe PES related to maladaptive psychological features, which might influence the perception of pain and analgesic opioid use in the postoperative period.
Keywords
Resumo
Introdução
A Medida Breve de Estresse Emocional Pré-operatório (B-MEPS) é uma ferramenta de triagem adequada para Estresse Emocional Pré-operatório (PES). Contudo, a tomada de decisão personalizada exige uma interpretação prática da versão refinada do B-MEPS. Assim, propomos e validamos pontos de corte no B-MEPS para classificar PES. Além disso, avaliamos se os pontos de corte rastreavam características psicológicas desadaptativas pré-operatórias e previam o uso de opioides no pós-operatório.
Métodos
Este estudo observacional compreende amostras de outros dois estudos primários, com 1.009 e 233 indivíduos, respectivamente. A análise de classe latente derivou subgrupos de estresse emocional usando itens do B-MEPS. Comparamos a adesão com a pontuação B-MEPS através do índice Youden. A validade de critério concorrente dos pontos de corte foi realizada com a gravidade dos sintomas depressivos pré-operatórios, catastrofização da dor, sensibilização central e qualidade do sono. A validade de critério preditiva foi realizada com o uso de opioides após a cirurgia.
Resultados
Escolhemos um modelo com três classes denominadas leve, moderada e grave. Os pontos do índice de Youden -0,1663 e 0,7614 do escore B-MEPS classificam os indivíduos, na classe grave, com sensibilidade de 85,7% (80,1%–90,3%) e especificidade de 93,5% (91,5–95,1%). Os pontos de corte do escore B-MEPS apresentam validade de critério concorrente e preditiva satisfatória.
Conclusão
Esses achados mostraram que o índice de estresse emocional pré-operatório no B-MEPS oferece sensibilidade e especificidade adequadas para discriminar a gravidade do estresse psicológico pré-operatório. Eles fornecem uma ferramenta simples para identificar pacientes propensos a PES grave relacionada a características psicológicas desadaptativas, que podem influenciar a percepção da dor e o uso de opioides analgésicos no pós-operatório.
Palavras-chave
References
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Submitted date:
07/27/2022
Accepted date:
02/18/2023
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