Prevalence of Preoperative Anxiety and Associated Factors Among Surgical Patients: Systematic Review and Meta-Analysis in Ethiopia

Abstract

Background: Preoperative anxiety is commonly characterized as a feeling of tension, apprehension, nervousness, distressing fear, and emotional discomfort preceding surgery. Different studies across the countries indicated an inconsistent prevalence of preoperative anxiety and its associated factors. Therefore, this study aimed to determine the pooled prevalence of preoperative anxiety and associated factors among surgical patients in Ethiopia.

Methods: In this study, all observational study designs conducted in Ethiopia were included while studies that did not report our main outcome of interest or did not meet the quality criteria by Joanna Briggs Institute (JBI) critical appraisal techniques were excluded. Electronic databases (PubMed, SCOPUS, Web of Science Core Collection, CAB Abstract, EMBASE, and CINHAL (EBSCO)), Google Scholar, and lists of references were used to search works of literature in Ethiopia. STATA version 17 was used for analysis, and the odds ratios of the outcome variable were determined using the random-effects model. Computing values assessed heterogeneity among the studies for I ² and P-values. Also, sensitivity analysis and funnel plot were done to assess the stability of pooled values to outliers and publication bias respectively.

Results: A total of 10 studies were included with a total of 3054 participants. The pooled prevalence of preoperative anxiety among surgical patients in Ethiopia was 60% (95% CI: 55-66, P < .001, I ² = 90.00%). The overall prevalence among non-obstetric patients was 59% (95% CI: 53-66) while among obstetric 66% (95% CI: 62-69). Fear of complication (AOR = 2.32, 95% CI: 1.23, 3.41, P = .62, I ² = 0.00%), postoperative pain (AOR = 1.92, 95% CI: 1.29, 2.56, P = .37, I ² = 0.00%), and fear of death (AOR = 2.27, 95% CI: 1.53, 3.00, P = .70, I ² = 0.00%) were significantly associated with preoperative anxiety.

Conclusion: This study revealed a high pooled prevalence of preoperative anxiety among surgical patients in Ethiopia. The findings showed that fear of complication, postoperative pain, and fear of death were significantly associated with preoperative anxiety. This implies that a multidisciplinary approach involving various healthcare professionals is essential to optimize patient care and outcomes by addressing postoperative pain through pain management, counselling on fear of death, and complications to reduce the level of preoperative anxiety.

Keywords: Ethiopia; Preoperative anxiety; meta-analysis; pooled prevalence; surgical patients; systematic review.

Figure 1.

PRISMA presentation for preoperative anxiety among surgical patients in Ethiopia, 2024. Abbreviations: n: number of studies included at each level.

Figure 2.

Forest plot of the overall prevalence of preoperative anxiety among surgical patients in Ethiopia, 2024.

Figure 3.

Forest plot that shows the sub-analysis prevalence of preoperative anxiety by study population among surgical patients in Ethiopia, 2024.

Figure 4.

Forest plot that shows the sub-analysis prevalence of preoperative anxiety by year of publication among surgical patients in Ethiopia, 2024.

Figure 5.

Forest plot for factors associated with preoperative anxiety among surgical patients in Ethiopia, 2024.

Figure 6.

Funnel plot that shows publication bias among included study.

Figure 7.

Meta-regression analysis to check heterogeneity on preoperative anxiety among surgical patients in Ethiopia, 2024.

Figure 8.

Meta-regression analysis by Galbraith plot to check heterogeneity on preoperative anxiety among surgical patients in Ethiopia, 2024.

Figure 9.

Sensitivity analysis of preoperative anxiety among surgical patients in Ethiopia, 2024.