Prevalence of pre-operative anxiety among adult patients undergoing elective surgery: A prospective observational single-centre study

Salihah Asiri, School of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia - School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia - Australian College of Perioperative Nurses (ACORN)Follow
Jed Duff, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia - Australian College of Perioperative Nurses (ACORN) - Department of perioperative services, Royal Brisbane & Women's Hospital, Brisbane, Australia Follow
Jane Currie, School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, AustraliaFollow
Michelle Guilhermino, School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, AustraliaFollow

Abstract

Objective: This study aimed to investigate the prevalence of pre-operative anxiety in elective surgical patients at a major metropolitan hospital in Australia.

Background: Globally, 310 million people are admitted for surgery every year. It is estimated that up to 80 per cent of these patients experience clinically relevant anxiety in the pre-operative period. Pre-operative anxiety can result in post-operative complications such as pain, delayed wound healing, surgical site infection, prolonged recovery and extended hospital stays. While preoperative anxiety has many negative consequences, this anxiety has often been overlooked in clinical practice.

Methods: A prospective study was conducted between November 2021 and June 2022, involving 308 adult patients scheduled for elective surgery. Pre-operative anxiety levels were measured using the Amsterdam pre-operative anxiety and information scale (APAIS), and age, sex and surgery type were collected.

Results: In total, 308 patients were enrolled, more than half (58%, n=279) were women. The mean (± SD) APAIS score out of 20 was 8.69 (± 4.08). Almost onethird (32.4%, n=100) of patients had significant pre-operative anxiety (APAIS score > 11/20). Women were three times more likely to experience anxiety than men (OR=3.39, 95% CI 1.97–5.82). Conversely, older patients were less likely to experience anxiety, with a reduction in anxiety of two per cent for each year above 18 years (OR=0.98, 95%CI 0.97–0.99). Patients reported higher anxiety levels related to the surgery itself compared to the anaesthesia, with mean scores of 5.04 (± 2.48) and 3.65 (± 2.07) out of 10, respectively. More than half the patients (54.9%, n=169) reported needing more information about anaesthesia and surgery.

Conclusions: Findings suggest that clinically relevant anxiety is common yet underdiagnosed. A higher prevalence is observed among females and those under the age of 30. The surgical procedure more than the anaesthesia was reported to cause higher anxiety.

Relevance to clinical practice: Identifying the prevalence of high preoperative anxiety highlights the importance of routine screening and the use of a standardised assessment tool for accurate evaluation in clinical practice. Prioritising interventions for at-risk groups, such as women and younger patients, is imperative to mitigate the risks of post-operative pain, delayed wound healing, surgical site infection, prolonged recovery and extended hospital stays.

Recommended Citation

Asiri, Salihah; Duff, Jed; Currie, Jane; and Guilhermino, Michelle (2024) "Prevalence of pre-operative anxiety among adult patients undergoing elective surgery: A prospective observational single-centre study," Journal of Perioperative Nursing: Vol. 37 : Iss. 3 , Article 2.
Available at: https://doi.org/10.26550/2209-1092.1270