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Multicenter Study
. 2025 Jul 3;112(7):znaf124.
doi: 10.1093/bjs/znaf124.

Prevalence and severity of pain, anxiety, stress, and sleep disturbances among surgical patients: a nationwide single-day multicentre flash mob study

Jetske M Stoop  1 , Roos Geensen  1 , Sophie C Adam  2 , Kayleigh A M van Dam  3 , Els van Dessel  4 , Annemarie Dolmans-Zwartjes  5 , Margot Heijmans  6 , Audrey C H M Jongen  7 , Mirjam Kaijser  8 , Chantal A Ten Kate  9 , Joanna Luttikhold  10 , Flores M Metz  11   12   13 , Laura van Zeggeren  14 ; PASS-Flash Mob Collaborator Group; Johannes Jeekel  1 , Markus Klimek  15
Collaborators, Affiliations
Multicenter Study

Prevalence and severity of pain, anxiety, stress, and sleep disturbances among surgical patients: a nationwide single-day multicentre flash mob study

Jetske M Stoop et al. Br J Surg. .

Abstract

Background: Patient-reported outcomes (PROs) are subjective health indicators including pain, anxiety, stress, and sleep disturbances. Despite their frequent occurrence in the perioperative period and potentially severe consequences for postoperative recovery (for example prolonged length of hospital stay, cardiovascular events, development of chronic pain), these are not acknowledged as complications and their exact prevalence remains unclear. This study aims to assess the prevalence and severity of pre- and postoperative pain, anxiety, stress, and sleep disturbances among surgical patients.

Methods: A nationwide single-day multicentre cross-sectional flash mob study was conducted in 29 Dutch hospitals. Adult surgical patients with an expected hospital stay of at least one night were included. Patients admitted for neurosurgery, cardiothoracic surgery, or orthopaedic surgery were excluded. Primary outcomes were self-reported pain, anxiety, stress, and sleep disturbances, as assessed with the Numeric Rating Scale, Visual Analogue Scale for Anxiety, Perceived Stress Scale, and the adapted Patient-Reported Outcome Measurement Information System respectively.

Results: Of the 1077 eligible patients, 733 (68%) patients (mean age of 64 ± 15.9 s.d. years, 51.8% male) completed participation. Moderate to severe pain was prevalent in 509 patients (69.7%) and occurred most frequently post-surgery. Anxiety occurred in 278 patients (38.1%) and was more prevalent preoperatively. Moderate to severe stress was reported by 272 patients (37.8%) with similar findings pre- and post-surgery. Sleep disturbances were prevalent in 440 patients (64.1%). Pain and anxiety were more severe in females. Sleep disturbances were more severe in patients with lower socioeconomic status.

Conclusion: Pain, anxiety, stress, and sleep disturbances are highly frequent complications among surgical patients in Dutch hospitals. Considering the prevalence and severity, we suggest implementing these relevant additional measures for PROs as indicators for routine postoperative evaluation to facilitate their management.

Plain language summary

When patients undergo surgery, they often experience pain, anxiety, stress, and sleep disturbances. These problems can affect their recovery after surgery, but doctors usually do not see them as complications, and we do not know exactly how frequently they occur. This study aimed to investigate how common and how severe pain, anxiety, stress, and sleep disturbances are before and after surgery. We performed a flash mob study, which means we collected all information in one day in 29 Dutch hospitals. We asked patients who were admitted to the hospital for surgical reasons and who stayed at least one night in the hospital to fill out a questionnaire. In one day, 733 patients filled out the questionnaire. Pain was present in about 7 of every 10 patients. Anxiety and stress were present in about 4/10 patients. Sleep disturbances were present in about 6/10 patients. These problems are very common in surgical patients. We suggest that these problems should be seen as complications and should be routinely evaluated before and after surgery to help manage them better.

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Figures

Fig. 1
Fig. 1
Flow chart *For example isolation, convict, recent return from surgery.
Fig. 2
Fig. 2
Pain in subgroups of sex, educational level, and monthly income *P < 0.05.
Fig. 3
Fig. 3
Anxiety in subgroups of sex, educational level, and monthly income *P < 0.05.
Fig. 4
Fig. 4
Stress in subgroups of sex, educational level, and monthly income *P < 0.05, PSS-10 = perceived stress scale.
Fig. 5
Fig. 5
Sleep disturbances in subgroups of sex, educational level, and monthly income *P < 0.05.
See this image and copyright information in PMC

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