Associations Among Preoperative Intrusive Thoughts, Postoperative Pain Intensity, and Thirst Within the Biopsychosocial Model: An Observational Study

Abstract

Background/Objectives: This study aimed to examine the associations of preoperative intrusive thoughts with postoperative pain intensity and thirst discomfort within a biopsychosocial framework. As a secondary exploratory objective, the study sought to estimate direct and indirect statistical associations among these variables using a path model. Methods: This observational, descriptive-correlational study included 130 patients who underwent laparoscopic cholecystectomy at the General Surgery Clinic of a state hospital in the Mediterranean Region between 1 August 2025 and 31 January 2026. Data were collected using the Patient Demographic Form, the Surgical Period Data Form, the Preoperative Intrusive Thoughts Inventory (PITI), the Numerical Rating Scale (NRS), and the Perioperative Thirst Discomfort Scale (PTDS). Results: The mean PITI total score was 18.78 ± 11.43, the mean NRS score was 5.23 ± 2.08, and the mean PTDS total score was 5.58 ± 2.72. Moderate positive correlations were found between PITI and NRS scores (r = 0.320, p < 0.001) and between PITI and PTDS scores (r = 0.303, p < 0.001). A weak positive correlation was also found between NRS and PTDS scores (r = 0.191, p < 0.05). In the secondary exploratory path analysis, the indirect statistical effect in the specified model involving postoperative NRS scores, preoperative PITI scores, and postoperative PTDS scores was statistically significant (indirect effect = 0.105, SE = 0.0448, 95% CI [0.0169, 0.192], p = 0.019), whereas neither the direct effect nor the total effect reached statistical significance. Conclusions: Preoperative intrusive thoughts were associated with postoperative pain intensity and thirst discomfort. These findings suggest that preoperative intrusive thoughts may be relevant to understanding postoperative symptom experiences within a biopsychosocial framework. Given the timing of the measurements, the exploratory indirect association should be considered hypothesis-generating rather than evidence of causal mediation.