Revista Sextante

Preoperative Anxiety and Its Associated Factors among Surgical Patients in Pakistan: A Cross-sectional Study

Anees Khan

Department of Healthcare Administration, Marywood University, USA

Tooba Chaudhary

Department of Biochemistry, University of Agriculture, Faisalabad

Dr. Manzoor Ahmed Khan

Assistant Professor Helper Eye Hospital Bolan Medical College, Quetta

Keywords: Preoperative Anxiety, APAIS, Associated Factors, Surgical Patients, Pakistan, Fear of Surgery, Cross-Sectional Study

---

Abstract

Background: Preoperative anxiety is a frequent but unrecognized condition which has a negative impact on intraoperative anesthetic use, postoperative pain, wound healing and hospital stay. There are limited and fragmented evidence from low and middle income countries, especially Pakistan. Objective: The purpose of this study was to find out the prevalence and severity of preoperative anxiety and socio-demographic, clinical and psychological parameters associated with it among adult surgical patients in tertiary care hospitals in Pakistan. Methods: A cross-sectional study was performed in a hospital setting in 300 adult patients undergoing elective surgery. Four tertiary care hospitals were selected from four divisions of the Punjab, Sindh, Khyber Pakhtunkhwa and Islamabad Capital Territory, and consecutive sampling was performed. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and a 7-item Fear-and-Concern inventory were completed the night before the surgery. The data were analysed using descriptive statistics, independent-samples t-tests, one-way ANOVA, Pearson correlation and multiple linear regression under the .05 level of significance (α = .05) in SPSS v.26. Findings: The overall mean APAIS anxiety score was 14.65 (SD = 3.97; range 4–20). Of the 252 respondents (84.0%), 45.3% had scores greater than the clinical cut-off score (>10); these were considered to be severely anxious. Anxiety was significantly higher among patients undergoing major surgery (M = 16.51 vs. 11.98, p < .001), first-time surgical patients (M = 15.61 vs. 12.68, p < .001), and those with comorbidities (p < .001). Educational attainment (F = 13.90, p < .001) and income (F = 7.08, p = .001) were inversely associated with anxiety. Multiple regression retained major surgery (β = 3.28), no previous surgery (β = 2.13), female gender (β = 1.25), low education (β = 1.17), low income (β = 1.17), comorbidity (β = 1.24), and fear-related cognitions as independent predictors (adjusted R² = .616). Conclusion:  Preoperative anxiety is a very common phenomenon in surgical patients and is a combination of socioeconomic disadvantage, clinical vulnerability and cognitive-affective fear responses. The provision of regular APAIS screening and multi-component psychoeducational services is highly recommended.