PhD S. (Stefan) van Beek

Below is a brief of the dissertation:

This thesis is about reducing anxiety and negative feelings that patients may experience before surgery. These emotions can lead to adverse postoperative effects. By reducing these emotions with premedication, the quality of postoperative recovery may potentially be improved.

Through a literature review, we found that benzodiazepine premedication in outpatient settings did not result in delayed discharge times and led to fewer postoperative side effects. However, we observed that the postoperative recovery quality was not perceived as better. We saw the same effect in hospitalized patients undergoing major abdominal surgery. Therefore, the routine administration of premedication to improve recovery quality is not recommended.

We have developed an initial predictive model to forecast the quality of postoperative recovery. In this way, we could selectively treat vulnerable patients with an expected poor recovery outcome postoperatively. The predictive value is still moderate, so there may be important predictive factors missing in this model.

Benzodiazepines carry a risk of postoperative confusion (delirium), especially in the elderly. This is why all guidelines advise against using these medications for premedication in older adults. However, our literature review found no evidence that a single dose of benzodiazepine premedication increases the risk of delirium. Therefore, guidelines may need to be adjusted, allowing older patients to receive premedication when indicated.