EFficacy of Family presence in the Operating Room during endovenous Treatment - An EFFORT Prospective Observational Study.

Abstract

Introduction: Varicose vein treatments are increasingly employing ambulatory endovenous procedures under local anesthesia. Despite their safety and feasibility, these procedures may induce significant psychological distress-a concern not currently addressed by exist guidelines. This study investigates the necessity for family presence (FP) during endovenous procedures and its effects on the disease treatment process, hypothesizing that FP can provide emotional support and enhance patient trust in medical staff.

Methods: This single-center, prospective observational study, conducted from September 2022 to March 2024, enrolled 175 patients scheduled for outpatient endovenous treatments. Participants were divided based on their preference for family presence during the surgery into FP (n=61, 34.9%) and No Family Presence (NFP, n=114, 65.1%) groups. The primary outcome was the influence of preoperative anxiety on the preference for FP, with secondary outcomes focusing on its impact on perioperative pain and postoperative satisfaction. Data collection followed the STROBE guidelines for observational studies, with preoperative anxiety assessed using a modified Amsterdam Preoperative Anxiety and Information Scale (mAPAIS).

Results: There were no significant demographic or clinical differences between the FP and NFP groups. In the NFP group, common reasons for declining FP included concerns about displaying anxiety (36%) and a perceived lack of necessity (29.8%). The FP group reported significantly higher mAPAIS scores (5.2±1.7 vs. 4.4±1.5, p=0.003) and a stronger preference for FP (3.4±1.1 vs. 2.1±0.8, p=0.001). Logistic regression analysis identified higher preoperative anxiety as a significant predictor of opting for FP (OR = 1.41, 95% CI: 1.07-1.88, p = 0.015). Most FP patients (78.7%) and guardians (85.2%) reported reduced anxiety, enhanced emotional support, and greater trust in the medical team. However, FP did not affect perioperative pain (p = 0.52) or postoperative three-month satisfaction scores (p = 0.42). Adverse events led to FP discontinuation in two (3.3%) of cases (one due to nausea, one due to syncope).

Conclusion: FP during endovenous procedures plays a crucial role in reducing preoperative anxiety and enhancing patient comfort. These findings suggest the potential for integrating family presence into clinical guidelines for minimally invasive procedures, promoting a more patient-centered approach in surgical care. Future studies should investigate the conditions under which FP is most beneficial, taking into account both patient preferences and procedural specifics.