Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 30;20(1):140.
doi: 10.1186/s12888-020-02552-w.

Preoperative anxiety in adults - a cross-sectional study on specific fears and risk factors

Leopold Eberhart  1   2 , Hansjörg Aust  1   2 , Maike Schuster  1 , Theresa Sturm  1 , Markus Gehling  1 , Frank Euteneuer  3   4 , Dirk Rüsch  5   6
Affiliations

Preoperative anxiety in adults - a cross-sectional study on specific fears and risk factors

Leopold Eberhart et al. BMC Psychiatry. .

Abstract

Background: Preoperative anxiety comprising anesthesia and surgery related anxiety is common and perceived by many patients as the worst aspect of the surgical episode. The aim of this study was to identify independent predictors of these three anxieties dimensions and to quantify the relevance of specific fears particularly associated with anesthesia.

Methods: This study was part of a cross-sectional survey in patients scheduled to undergo elective surgery. Anxiety levels were measured with the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Modified numeric rating scales (mNRS, range 0-10) were used to assess the severity of eight selected specific fears which were predominantly analyzed descriptively. Multivariate stepwise linear regression was applied to determine independent predictors of all three anxiety dimensions (APAIS anxiety subscales).

Results: 3087 of the 3200 enrolled patients were analyzed. Mean (SD) total preoperative anxiety (APAIS-A-T, range 4-20) was 9.9 (3.6). High anxiety (APAIS-A-T > 10) was reported by 40.5% of subjects. Mean (SD) levels of concern regarding the eight studied specific fears ranged from 3.9 (3.08) concerning "Anesthesiologist error" to 2.4 (2.29) concerning "Fatigue and drowsiness" with an average of 3.2 (2.84) concerning all specific fears. Ranking of all specific fears according to mean mNRS scores was almost identical in patients with high versus those with low anxiety. Among nine independent predictors of anxiety, only 3 variables (female gender, negative and positive anesthetic experience) independently predicted all three APAIS anxiety subscales. Other variables had a selective impact on one or two APAIS anxiety subscales only. Female gender had the strongest impact on all three APAIS anxiety subscales. Adjusted r2 values of the three models were all below 13%.

Conclusions: The high variability of importance assigned to all specific fears suggests an individualized approach is advisable when support of anxious patients is intended. Considering independent predictors of anxiety to estimate each patient's anxiety level is of limited use given the very low predictive capacity of all three models. The clinical benefit of dividing patients into those with high and low anxiety is questionable.

Trial registration: German Registry of Clinical Trials (DRKS00016725), retrospectively registered.

Keywords: Anesthesia related anxiety; Cross-sectional survey; Independent predictors; Multivariate regression; Preoperative anxiety; Specific concerns; Surgery related anxiety.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

References

    1. Walker EM, Bell M, Cook TM, Grocott MP, Moonesinghe SR. Patient reported outcome of adult perioperative anaesthesia in the United Kingdom: a cross-sectional observational study. Br J Anaesth. 2016;117(6):758–766. doi: 10.1093/bja/aew381. - DOI - PubMed
    1. Aust H, Eberhart L, Sturm T, Schuster M, Nestoriuc Y, Brehm F, et al. A cross-sectional study on preoperative anxiety in adults. J Psychosom Res. 2018;111:133–139. doi: 10.1016/j.jpsychores.2018.05.012. - DOI - PubMed
    1. Aust H, Rusch D, Schuster M, Sturm T, Brehm F, Nestoriuc Y. Coping strategies in anxious surgical patients. BMC Health Serv Res. 2016;16:250. doi: 10.1186/s12913-016-1492-5. - DOI - PMC - PubMed
    1. Matthey P, Finucane BT, Finegan BA. The attitude of the general public towards preoperative assessment and risks associated with general anesthesia. Can J Anaesth. 2001;48(4):333–339. doi: 10.1007/BF03014959. - DOI - PubMed
    1. Kindler CH, Harms C, Amsler F, Ihde-Scholl T, Scheidegger D. The visual analog scale allows effective measurement of preoperative anxiety and detection of patients’ anesthetic concerns. Anesth Analg. 2000;90(3):706–712. doi: 10.1097/00000539-200003000-00036. - DOI - PubMed

Publication types