Perioperative Monitoring to Assess Preoperative Anxiety in Inflammatory Bowel Disease Patients

Istituto Clinico Humanitas80 enrolled

Overview

Anxiety and depression are extremely common among Inflammatory Bowel Disease (IBD) patients undergoing surgery and may increase the risk of postoperative adverse outcomes. This study aims to objectively evaluate preoperative psychological distress by remotely measuring the patient's physiological parameters and Heart Rate Variability (HRV) with the Howdy Senior ® device (Comftech Srl). Additionally, the study will also investigate the feasibility and effectiveness of the Howdy Senior® device in improving the postoperative patient's monitoring.

Inflammatory Bowel Disease (IBD) patients are at high risk of postoperative complications and delayed recovery. Preoperative anxiety and low patient's awareness of the disease may increase the risk of postoperative complications inducing an autonomic impairment which may in turn determine an inflammatory unbalance. This correlation can be confirmed through the preoperative monitoring of the autonomic function- with wearable electrocardiogram (ECG) devices. The Howdy Senior® device (ComfTech Srl) allows the real-time remote ECG monitoring and the computation of stress and fatigue indexes. The Howdy Senior® device may also provide a reliable tool for remotely monitoring the patient's clinical parameters after discharge. This study aims to explore the pathophysiological mechanisms linking preoperative anxiety and autonomic response and assess the feasibility and effectiveness of the Howdy Senior® device for the postoperative patients' remote monitoring.

Study Type

INTERVENTIONAL

Allocation

NON_RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

Conditions

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Patients aged more than 18 years old. * Established Crohn's disease (CD) or Ulcerative Colitis (UC) at the time of surgery indication with a proven histological diagnosis. * Patients scheduled for elective intestinal resection. Exclusion Criteria: * Diagnosis of Undetermined Colitis. * Recurrent disease. * Concomitant diagnosis of malignancy. * Established diagnosis of major depressive disorder or anxiety disorder. * Diagnosis of ventricular or supraventricular arrythmia. * Active pharmacological treatment with β-blockers or other drugs affecting the heart rate. * Known hypersensitivity to cotton or silver. * Emergent surgery. * Planned open surgery. * Any concomitant surgery unrelated to the main surgical indication. Patients undergoing perianal surgery for related perianal disease can be included in the study.

Outcomes

Primary Outcomes

Correlation between preoperative anxiety and preoperative Heart Rate Variability (HRV)

Correlation between preoperative anxiety- assessed through the Hospital Anxiety and Depression Scale (HADS) (Self-reporting scale ranging from 0 to 21, where significant anxiety and depression are identified by a 8 point cut-off) and the median value of at least three Heart Rate Variability (HRV) measures collected in the preoperative period through the Howdy Senior® device.

Time frame: From 14 days to 1 day before surgery

Secondary Outcomes

Correlation between preoperative anxiety and 90-day Comprehensive Complication Index (CCI)

Correlation between preoperative anxiety- assessed through the Hospital Anxiety and Depression Scale (HADS) (Self-reporting scale ranging from 0 to 21, where significant anxiety and depression are identified by a 8 point cut-off) and the median value of the Comprehensive Complication Index (CCI) (Index ranging from 0 (no complication) to 100 (death)) at 90 days after the surgical intervention

Time frame: 90 days after surgery

Correlation between preoperative anxiety and preoperative Patient Health Engagement Scale (PHE-S)

Correlation between preoperative anxiety- assessed through the Hospital Anxiety and Depression Scale (HADS) (Self-reported scale ranging from 0 to 21, where significant anxiety and depression are identified by a 8 point cut-off) and the preoperative Patient Health Engagement Scale (PHE-S, self-reporting scale ranging from 0 (complete disease awareness) to 12 (complete absence of disease awareness).

Time frame: From 14 days to 1 day before surgery

Correlation between preoperative anxiety and C-Reactive Protein (CRP) level 24 hour after surgery

Correlation between preoperative anxiety- assessed through the Hospital Anxiety and Depression Scale (HADS) (Self-reported scale ranging from 0 to 21, where significant anxiety and depression are identified by a 8 point cut-off) and the level of serum C-Reactive Protein (CRP, µg/mL) measured 24 hours after surgery.

Time frame: 24 hours after surgery

90-day postoperative complications

Rate difference of 90-day postoperative complications (classified according to the Clavien-Dindo scale) between the interventional cohort and the historical cohort of comparison.

Time frame: 90 days after surgery

Correlation between the 90-day Postoperative Recovery Profile (PRP) and 90-day Heart Rate Variability (HRV)

Correlation between the 90-day Postoperative Recovery Profile (PRP) (Scale ranging from 0 (completely recovered) to 68 (not recovered)) and the median value of at least twelve Heart Rate Variability (HRV) measures collected in the postoperative period through the Howdy Senior® device.

Time frame: 90 days after surgery

Healthcare costs

Median difference of the healthcare resources used in the interventional cohort and the historical cohort of comparison.

Time frame: 6 months after surgery

Perioperative Monitoring to Assess Preoperative Anxiety in Inflammatory Bowel Disease Patients

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts