Conference Coverage

Preoperative Anxiety and Systemic Inflammation Linked to Lower Knee Surgery Satisfaction

Edited by:
Brian McCurdy

Key Highlights

  • Six-month satisfaction data were available for 166 adults undergoing knee surgery.
  • Higher preoperative anxiety and C-reactive protein (CRP) were independently associated with lower satisfaction.
  • Pain at 3 and 6 months was associated with lower satisfaction in univariable analyses, but not after multivariable adjustment.
  • Findings were consistent in a sensitivity analysis of 148 patients undergoing unilateral procedures.

Higher preoperative anxiety and systemic inflammation were independently associated with lower satisfaction 6 months after knee surgery in a retrospective cohort study. Although postoperative pain was associated with satisfaction in univariable analyses at later time points, it was not independently associated after adjustment.

Investigators from Gifu Seiryu Hospital in Gifu, Japan, presented the findings at the ANESTHESIOLOGY Annual Meeting 2026 in San Diego. The researchers examined whether psychological distress and inflammation before surgery were associated with satisfaction through a pathway independent of postoperative pain.

The study included adults undergoing knee surgery under standardized perioperative management. Its primary outcome was satisfaction at 6 months, assessed using the Knee Society Score (KSS) satisfaction subscale. Researchers selected candidate predictors in advance based on clinical relevance and prior literature.

Researchers assessed pain at 3 and 6 months, defined as a numeric rating scale score >3 or analgesic medication use, and movement-evoked visual analog scale pain scores on postoperative days 3 and 7. Other predictors included preoperative anxiety measured with the Hospital Anxiety and Depression Scale-Anxiety subscale, baseline KSS expectations, and preoperative CRP. Multivariable linear regression identified independent predictors, with a prespecified sensitivity analysis restricted to unilateral procedures.

Study Findings

Six-month satisfaction data were available for 166 patients. Pain at 3 and 6 months was associated with lower satisfaction in univariable analyses. Acute movement-evoked pain on postoperative days 3 and 7 showed no significant association. Neither subacute nor chronic pain remained independently associated with satisfaction after multivariable adjustment.

Higher preoperative anxiety independently predicted lower satisfaction (β = −0.67; 95% CI, −1.04 to −0.30; P = .00044). Higher preoperative CRP was also independently associated with lower satisfaction (β = −2.82; 95% CI, −4.78 to −0.87; P = .00494). Baseline expectations were not predictive in the adjusted model (β = 0.11; P = .79). The direction and magnitude of these associations were consistent among the 148 patients undergoing unilateral procedures.

Clinical Implications

According to the investigators, the findings support a pain-independent pathway for satisfaction after knee surgery, emphasizing preoperative psychological distress and systemic inflammation. They characterized these as modifiable factors and concluded that postoperative pain alone did not independently determine 6-month satisfaction.

Expert Commentary

“Six-month satisfaction after knee surgery was not independently determined by postoperative pain intensity, despite a univariable association with pain at later time points,” the researchers concluded.

Reference

Yamada Y, Tachi J, Matsumoto K. A pain-independent satisfaction pathway after knee surgery: psychological distress and preoperative inflammation. Abstract presented at: ANESTHESIOLOGY 2026; October 16–20, 2026; San Diego, CA. Abstract A1024.