The role of pre-operative state-anxiety in the determination of intra-operative neuroendocrine responses and recovery


Correspondence should be addressed to Sue Pearson, The University of South Australia, Division of Health Sciences, City East Campus, North Terrace, Adelaide, South Australia 5000, Australia (e-mail:


Objectives. The psychophysiological model of adjustment to surgery predicts associations between (1) heightened pre-operative state-anxiety and intra-operative neuroendocrine responses, (2) neuroendocrine responses and complications; and (3) heightened pre-operative state-anxiety and post-operative recovery. The present study examined these associations.

Methods. Participants were 39 patients (mean age 71.9±6.1 years) undergoing elective carotid endarterectomy surgery under local anaesthesia. In the week prior to surgery, patients completed baseline measures of physical and mental functioning using the MOS 36-item Short-Form Health Survey (SF-36). In addition to this, they undertook a 24-hour urine save to measure cortisol and catecholamines. Measures of state-anxiety were completed on the evening prior to surgery. A second 24-hour urine save was started at the time of anaesthetic induction. Follow-up measures of physical and mental functioning were completed 1 month following surgery. All complications were recorded during hospitalization.

Results. There was a significant negative association between pre-operative state-anxiety and intra-operative cortisol (r =−.52, p ≤.001). Using hierarchical regression analysis, pre-operative state-anxiety accounted for 10% of the variance in intra-operative cortisol responses after controlling for medical and demographic factors. There were no significant associations between neuroendocrine responses and complications. Pre-operative state-anxiety was a significant determinant of poorer mental functioning following surgery, explaining 10% of the variance in scores after adjusting for baseline mental functioning.

Conclusions. Results from this study show increasing pre-operative anxiety to be associated with lower intra-operative cortisol responses and poorer mental functioning 1 month following surgery.