Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia

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

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.

Stress Reduction in Perioperative Care: Feasibility Randomized Controlled Trial

BACKGROUND

Patients undergoing surgery often experience stress and anxiety, which can increase complications and hinder recovery. Effective management of these psychological factors is key to improving outcomes. Preoperative anxiety is inversely correlated with the amount of information patients receive, but accessible, personalized support remains limited, especially in preoperative settings. Face-to-face education is often impractical due to resource constraints. Digital health (DH) interventions offer a promising alternative, enhancing patient engagement and empowerment. However, most current tools focus on providing information, overlooking the importance of personalization and psychological support.

OBJECTIVE

This study aimed to assess the viability of a DH intervention known as the Adhera CARINAE DH Program. This program is specifically designed to offer evidence-based and personalized stress- and anxiety-management techniques. It achieves this by using a comprehensive digital ecosystem that incorporates wearable devices, mobile apps, and virtual reality technologies. The intervention program also makes use of advanced data-driven techniques to deliver tailored patient education and lifestyle support.

METHODS

A total of 74 patients scheduled for surgery across 4 hospitals in 3 European countries were enrolled in this study from September 2021 to March 2022. Surgeries included cardiopulmonary and coronary artery bypass surgeries, cardiac valve replacements, prostate or bladder cancer surgeries, hip and knee replacements, maxillofacial surgery, and scoliosis procedures. After assessment for eligibility, participants were randomized into 2 groups: the intervention group (n=23) received the Adhera CARINAE DH intervention in addition to standard care, while the control group (n=27) received standard care alone. Psychological metrics such as self-efficacy, self-management, and mental well-being were assessed before and after the intervention, alongside physiological markers of stress.

RESULTS

The intervention group demonstrated significant improvements across several psychological outcomes. For example, Visual Analogue Scale Stress at the hospital improved at admission by 5% and at hospital discharge by 11.1% and Visual Analogue Scale Pain at admission improved by 31.2%. In addition, Hospital Anxiety and Depression Scale Anxiety after surgery improved by 15.6%, and Positive and Negative Affect Scale-Negative at hospital admission improved by 17.5%. Overall, patients in the intervention study spent 17.12% less days in the hospital. Besides these individual scores, the intervention group shows more positive relationships among the psychological dimensions of self-efficacy, self-management, and mental well-being, suggesting that the CARINAE solution could have a positive effect and impact on the reduction of stress and negative emotions.

CONCLUSIONS

Our results provide an important first step toward a deeper understanding of optimizing DH solutions to support patients undergoing surgery and for potential applications in remote patient monitoring and communication.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05184725; https://clinicaltrials.gov/study/NCT05184725.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/38536.

Cross-sectional and Correlational Examination of Patients' Preoperative Anxiety, Information Need, and Health Literacy in a Presurgical Consultation

PURPOSE

This study elucidates the preoperative anxiety (PA), information need (IN), and health literacy (HL) levels of an elective preoperative sample in Switzerland and examines the possible associations between PA and the patients' characteristics. By knowing these patient dimensions, which can influence perioperative outcomes, one can tailor individualized nursing interventions to improve patients' surgical experience.

DESIGN

This was a cross-sectional and correlational study.

METHODS

The sample consisted of 88 patients who underwent a preoperative consultation at a Swiss tertiary hosptial. Patients' PA and IN were assessed using the Anxiety Preoperative and Information Scale, and their HL was measured using the Functional, Communicative, and Critical Health Literacy Scale. Data on other patient characteristics were collected from the patients, physicians, and electronic patient records. Association tests, as well as univariate regressions, were performed on PA, IN, HL, and patient characteristics.

FINDINGS

Among participants, 40.91%, 78.41%, and 59% reported having PA, IN, and low HL, respectively. Finally, PA was associated with IN, HL, solitary living, and the American Society of Anesthesiology score.

CONCLUSIONS

A high proportion of patients scheduled for presurgical consultation were found to be anxious. They presented high IN and low HL. An examination of patients' PA-associated characteristics can help improve their surgical experience. More studies should examine PA-associated characteristics.

Reddit Perspectives on Tonsillectomy Procedure: Sentiment and Thematic Analysis

INTRODUCTION

Every year, 530,000 tonsillectomies are performed in the United States. Many patients use social media for medical advice and support. This study investigates Reddit perspectives to identify the current needs of tonsillectomy patients.

METHODS

The "Top" 500 posts of the r/tonsillectomy subreddit community (3600 members) were qualitatively classified by theme, author, and post content. A Python sentiment analysis package, Valence Aware Dictionary sEntiment Reasoner (VADER), assigned summary Compound scores (-1=most negative, +1=most positive). A Lexicon-based syuzhet package analyzed the emotions of each post. Word frequency analysis elucidated top descriptors. Kruskal-Wallis and Mann-Whitney tests were used to determine statistical significance.

RESULTS

Posts were themed as Attitudes/Experiences (n=440, 88%), Medical/Procedural (n=9, 1.8%), or Both (n=51, 10.2%). Most were patient-authored (n=474, 94.8%), with many sharing personal anecdotes (n=476, 95.2%) and seeking validation (n=109, 21.8%). Few involved preoperative (n=15, 3%) or postoperative (n=45, 9%) concerns, with no operative or medication-related questions. VADER analysis revealed an average Compound score of 0.26, with 320 Positive, 179 Negative, and one Neutral post. Fear and trust had the most associated words from the National Research Council (NRC) Emotion dictionary. Common descriptors were "pain" (n=2063), "throat" (n=718), "water" (n=675), "feel" (n=576), and "ice" (n=328).

CONCLUSION

Most Reddit users viewed their tonsillectomy experience as positive. Many shared experiences and a few of them involved clinical questions. The descriptor "pain" was particularly prevalent. Providers should supply detailed pain-related expectations. Reddit may allow surgeons to better grasp how real patients manage pain, combining home remedies with prescribed medications. Care can be enhanced through personalized support that aims to minimize fear and improve patient-physician trust.

Perceived compassionate care and preoperative anxiety in hospitalized patients

BACKGROUND

Quality nursing care and ethical responses to patient pain and suffering are very important in the preoperative period. However, few studies have addressed these variables.

OBJECTIVE

This study aimed to examine the relationship between compassionate care and preoperative anxiety from the perspective of hospitalized patients.

METHODS

The current study was a cross-sectional descriptive one. The participants were selected using convenience sampling. The data were collected using a demographic questionnaire, Burnell Compassionate Care Tool, and Amsterdam Preoperative Anxiety and Information Scale (APAIS). The collected data were analyzed with SPSS software (version 22) through descriptive and inferential statistics at a significance level of 0.05 (p < .05).

PARTICIPANTS AND SETTING

This study was conducted on 704 candidates for surgery in the internal and surgical wards of a large teaching hospital located in the south of Iran from December 2022 to March 2023.

ETHICAL CONSIDERATIONS

The protocol for this study was reviewed and approved by the University Ethics Committee.

FINDINGS

The patients' average age was 36.61 ± 13.07. The average preoperative anxiety and need for information scores were 13.80 ± 2.66 and 7.44 ± 1.47, respectively. The average score of importance was 3.03 ± 0.19, and the average score of the extent of compassionate care provision was 1.22 ± 0.15. There was a significant relationship between preoperative anxiety with importance and the extent of compassionate care provision (r = 0.68, p < .001), r = -0.72, p < .001, respectively). A comparison of the demographic characteristics, need for information, importance, and provision of compassionate care showed that the extent of compassionate care provision had the greatest contribution in explaining preoperative anxiety (β = 0.50; p < .001).

CONCLUSION

Even though patients' preoperative anxiety was high and providing compassionate care in the preoperative period had a great role in relieving their anxiety, many participants appear to have received little compassionate care. To this end, nursing managers should pay attention to the quality of compassionate care in the preoperative stage. Besides, healthcare staff should receive the necessary training in compassionate nursing care.

Impact of virtual reality hypnosedation on perioperative pain and anxiety in port implantation under local anesthesia: a randomized controlled pilot trial (VIP Trial)

BACKGROUND

This monocentric randomized controlled pilot trial investigates the impact of virtual reality (VR) hypnosedation on perioperative anxiety, pain, patient satisfaction, and medication usage during port implantation under local anesthesia.

METHODS

A total of 120 patients undergoing elective port implantation between January 2022 and August 2023 were enrolled and randomized in a 1:1 ratio to either a VR hypnosedation group or a control group. The VR group used a commercially available VR headset with the HypnoVR application, providing various environments, musical backgrounds, and a guiding voice, while the control group underwent the procedure without VR. Patients with ASA > 3, chronic pain, cognitive issues, and contraindications against VR use were excluded. The main outcomes measured were perioperative pain and anxiety scores, with secondary outcomes including perioperative medication usage. Due to the nature of the interventions, blinding of patients and physicians was not feasible. Statistical analysis was primarily descriptive and exploratory, focusing on estimating effect sizes for future trials.

RESULTS

The study found no significant differences in immediate postoperative pain with 1.43 ± 1.63 vs. 1.6 ± 2.05 (p = 0.62) or anxiety scores 30.65 ± 9.13 vs. 31.78 ± 13.34 (p = 0.60) between the no VR and VR group, respectively. Additionally, there was a trend to less usage of certain medications, particularly remifentanil (mean dose of 200 mg vs. 100 mg (p = 0.12)) and novaminsulfon (mean dose of 1250 mg vs. 900 mg (p = 0.26)) in the VR group vs. no VR group, respectively. However, these differences were not statistically significant and therefore no definitive conclusions can be drawn regarding medication usage based on this data.

CONCLUSION

While VR hypnosedation did not significantly reduce perioperative pain or anxiety in this pilot trial, the observed trends in reduced medication usage suggest potential benefits. These findings warrant further investigation in larger, confirmatory trials to better understand the role of VR in enhancing patient comfort and potentially reducing reliance on pharmacological interventions during surgical procedures.

TRIAL REGISTRATION

German Clinical Trials Register: DRKS00028508; registration date 15 March 2022; Universal Trial Number: U1111-1275-4995.

Effects of Music on Pain and Anxiety During Otolaryngology Surgery: A Systematic Review and Meta-analysis

Objective

Patients undergoing surgery commonly experience anxiety during their procedure which can negatively affect surgical outcomes. Music therapy has emerged as a promising noninvasive approach to reducing anxiety particularly in patients undergoing otolaryngology procedures.The objective of this study is to evaluate the effectiveness of music therapy on anxiety and pain during these procedures.

Data Sources

PubMed and Embase.

Review Methods

A systematic search was conducted using the PRISMA approach to retrieve articles published between 1980 and March 2024. The search terms were applied to PubMed and Embase databases. The search term yielded a total of 669 articles on PubMed and 1027 articles on Embase, 5 of which met the inclusion criteria.

Results

Five studies consisting of 4 randomized controlled trials and one case-control studies were included in our study, resulting in a total of 381 patients undergoing various otolaryngology procedures. Music therapy was found to reduce preoperative, perioperative, and postoperative anxiety and pain levels compared to control groups. Furthermore, patients who received music therapy experienced improvements in physiological parameters such as heart rate and blood pressure, indicating a positive impact on stress.

Conclusion

Music therapy offers a potentially cost-effective and noninvasive method of reducing anxiety and pain in otolaryngological surgery patients. Our study indicates that music therapy can serve as a valuable addition to traditional pharmacological approaches in managing surgery-related anxiety and pain. However, more research is needed to standardize music therapy protocols and compare its effect in comparison to other nonpharmacologic and pharmacologic modalities to optimize care for patients.

Significant Preoperative Anxiety Associated with Perceived Risk and Gender in Cataract Surgery

Background/Objectives: Cataract surgery is an often-sought solution to the universal problem of lens opacification. Studies of perioperative anxiety have yielded conflicting results, reporting a high prevalence but low clinical significance. The objective of this study was to ascertain anxiety levels immediately after the scheduling of surgery, controlling for trait anxiety and other related factors. Methods: This is an observational comparative study of two patient populations assessed for receiving cataract surgery, with one group of seventy patients scheduled for operation and receiving an assessment of the potential perioperative risk and the other group of seventy patients deemed ineligible for operation since their opacification was not advanced. The patients were assessed for state and trait anxiety while controlling for cognitive status. Results: The findings indicate a clinically significant burden of state anxiety in the group of patients scheduled for operation, with 34 out of 70 meeting the threshold for clinically significant levels of state anxiety compared to 9 out of the 70 patients who were not assigned for surgery (p < 0.001). Those patients who were assigned for surgery were assessed for perioperative risk factors, and state anxiety differed statistically significantly between the preoperative risk factor groups, (p = 0.003) with those assessed as having at least low perioperative risk presenting with more anxiety than those without any risk factors. Male patients exhibited lower state anxiety compared to female patients in the group assigned to surgery (p = 0.028). Cognitive status did not affect the results. Conclusions: These findings point to the importance of prevention against perioperative anxiety early on, especially in patients with a higher perioperative risk and female gender.

Preoperative anxiety, postoperative pain tolerance and analgesia consumption: A prospective cohort study

BACKGROUND

Anxiety affects the patient's perception of postoperative pain and causes a significant increase in the consumption of analgesia postoperatively.

OBJECTIVE

This study assesses the relationship between preoperative anxiety, postoperative pain and postoperative pethidine consumption.

METHODS

A prospective cohort design was used. Data were collected from 100 patients who were undergoing a laparoscopic cholecystectomy at St Joseph Hospital, Jerusalem. Pain-controlled analgesia with pethidine was utilised to manage pain throughout the postoperative period. The visual analogue scale scores and pethidine consumption of all patients were recorded.

FINDINGS

Participants' mean level of pain was higher in the preoperative period (mean visual analogue scale = 1.3) compared with their mean level of pain in the postoperative period (mean visual analogue scale = 0.5). There is a statistically significant difference between the participants' level of anxiety and postoperative pain level (p < 0.001). Gender, weight, level of education and smoking were predictors of developing preoperative anxiety. Also, gender, smoking and medication were statistically significant predictors of developing postoperative pain. Furthermore, gender, medical history and medication were statistically significant predictors of pethidine consumption postoperatively.

CONCLUSIONS

The preoperative anxiety reduction intervention should be promoted and implemented as routine care for all surgical patients.

The Effect of Lidocaine-Prilocaine Cream Combined with or Without Remimazolam on VAS and APAIS Anxiety Score in Patient Undergoing Spinal Anesthesia

Purpose

This study aimed to investigate patients' expectative pain of spinal anesthesia puncture and anxiety pre-anesthesia, and to examine the effect of lidocaine-prilocaine cream and remimazolam prior to spinal anesthesia puncture on pain relief and anxiety release.

Methods

Patients undergoing spinal anesthesia were divided into control, lidocaine-prilocaine cream, and lidocaine-prilocaine cream with remimazolam groups. A questionnaire consisting of The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and patient's concerns and Visual Analog Scale (VAS) was used to evaluate patient's anxiety and pain. The primary outcomes were differences in VAS and anxiety scores. Patient's spinal anesthesia-related concerns, advent events and hemodynamic index were also recorded.

Results

The expected spinal anesthesia puncture pain was 5.34±0.27 and anxiety scores before spinal anesthesia was 10.88 ± 0.64. A statistically significant positive correlation of 31.3% was detected between VAS and APAIS scores (r = 0.313; P=0.003). The VAS score at the time of puncture decreased by 29.7% (3.78±0.40, P=0.001) in lidocaine-prilocaine cream group and 29.2% (3.75±0.39, P=0.001) in lidocaine-prilocaine cream with remimazolam group compared with the expected VAS score. Lidocaine-prilocaine cream combined with or without remimazolam reduced the percentage of moderate pain (21.4% and 31.3% vs 50.0%, P=0.0001) and increased mild pain (60.7% vs 59.4% vs 22.7%, P=0.03). Anxiety score in lidocaine-prilocaine cream group was reduced by 2.84 (8.04±0.76 vs 10.88 ± 0.46, P=0.05) when compared with pre-anesthesia. Concerns about postoperative pain (P=0.03) and fear of the needle or intervention (P=0.000) both decreased post-anesthesia among groups.

Conclusion

Approximately half of the patients scheduled for spinal anesthesia experienced a moderate level of preoperative anxiety. The patient's pain expectation from the spinal anesthesia puncture was moderate, which was higher than the actual pain. Lidocaine-prilocaine cream with or without remimazolam sedative before spinal anesthesia puncture reduced the patient's pain and anxiety scores after surgery.

Anxiety and associated factors among medical and surgical patients in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Individuals diagnosed with chronic medical conditions and patients appointed to undergo surgery face various degrees of anxiety as a result of doubts related to the outcome of surgery, and the psycho-socioeconomic costs of the medical illness. This can affect the treatment process and even the outcome of patients with medical and surgical cases. Though different studies were conducted on anxiety and associated factors among medical and surgical patients in Ethiopia, the findings were found to be inconsistent and had a wide discrepancy. So, this systematic review and meta-analysis estimated the pooled effect size of anxiety among this population and guides to plan appropriate intervention at a national level.

METHODS

Studies conducted on anxiety and associated factors among medical and surgical patients in Ethiopia were included. Data was extracted using Microsoft Excel and analyzed using STATA version 11. The random-effects model was used to estimate the pooled effect size of anxiety and its determinants with 95% confidence intervals. Funnel plots and Egger's regression tests were employed to check publication bias. Sub-group and sensitivity analyses were also conducted.

RESULTS

The pooled prevalence of anxiety among medical and surgical patients in Ethiopia was found to be 48.82% with a 95% CI (42.66, 54.99). Being female[OR = 2.84(2.02, 4.01)], fear of death [OR = 2.93(1.57, 5.50)], and history of surgery[OR = 0.42(0.27, 0.065)], among surgical patients and being female[OR = 2.35(1.94, 2.850], having poor social support[OR = 2.22(1.62, 3.05)], perceived stigma[OR = 4.25(1.97, 9.18)] and family history of mental illness[OR = 1.86(1.21, 2.86)] among medical patients were significantly associated with anxiety in this systematic review and meta-analysis.

CONCLUSION AND RECOMMENDATION

The pooled prevalence of anxiety among medical and surgical patients in Ethiopia was found to be high. Therefore, it would be good for professionals to screen patients for anxiety besides managing their medical or surgical cases to detect them early and address them.

Design of a nursing psychoeducation program to reduce preoperative anxiety in adults

Introduction

Preoperative anxiety, with its multifactorial origins, affects a wide range of surgical patients, leading to adverse physiological and psychological effects in the perioperative period. Customized, autonomous nursing interventions are needed to address individual person needs. The shift toward outpatient surgery emphasizes the need for restructured nursing approaches. Existing literature suggests that preoperative nursing consultations offer opportunities for assessing needs, providing information, and prescribing anxiety-reduction strategies. Psychoeducation, a specialized skill within mental health and psychiatric nursing, has proven effective in alleviating preoperative anxiety and reducing postoperative complications. The aim is to obtain and analyze the information reflecting nurses’ understanding of the design, structure, and operationalization of a psychoeducation program to reduce preoperative anxiety in adults.

Methods

A qualitative, exploratory, descriptive study was conducted. Data were collected through a 90-min focus group session held online via Zoom Meetings videoconferencing platform. Inclusion criteria for the participant’s selection were established. The focus group was guided to deliberate on potential strategies for crafting effective psychoeducational interventions. Data collection ceased upon reaching theoretical saturation and gathered information was submitted for content analysis. Ethical procedures were ensured.

Results

Of the participants, 10 were specialist nurses (7 working in mental health and psychiatric nursing and the remaining in medical-surgical nursing), with an average age of 41 and an average of 15 years working in surgical services. The nurses selected the target population, the structure and content of the psychoeducation sessions, and the resources and addressed the perceived importance, effectiveness, and feasibility of the designed psychoeducation program.

Discussion

The study revealed the nurses’ understanding of the design of a psychoeducation program potentially effective in reducing preoperative anxiety in adults, in an outpatient surgery context. This result will allow the transfer of the produced knowledge to nurses’ professional practice reflecting lower levels of anxiety and promoting a better surgical recovery. This is an unprecedented study conducted in Portugal, adding substantial knowledge to the nursing discipline. However, further research into implementing psychoeducation in a surgical context is suggested aiming to consolidate the results of research already carried out internationally.

Validation of Kannada Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS)

BACKGROUND AND AIM

Preoperative anxiety is a complex and subjective phenomenon, most commonly observed in patients posted for elective surgery. The Amsterdam Preoperative Anxiety Information Scale (APAIS) has been widely used in preoperative settings to measure anxiety quickly. This study aimed to translate the APAIS into Kannada and to evaluate its psychometric properties.

METHOD

The study involved forward and backward translation of APAIS into Kannada followed by a cognitive interview of 10 patients by clinical psychologist to confirm the correct translation. The translated version was then administered to 240 patients who were posted for elective surgery along with the Visual Analogue Scale for Anxiety (VAS-A). Reliability and internal consistency were assessed by calculating Cronbach's alpha. Construct validity was assessed by principal component analysis and confirmatory factor analysis. Criteria validity was assessed by evaluating the correlation between APAIS and VAS-A.

RESULT

The Kannada-translated version of APAIS was completed by 224 patients posted for elective surgery. Cronbach's alpha was 0.82 and 0.83 for anxiety and need for information items, respectively. Root mean square error of approximation (RMSEA), comparative fit index (CFI), and Tucker-Lewis index (TLI) were 0.07, 0.98, and 0.96, respectively, for three-factor model, indicating it to be best fit for Kannada version of APAIS.

CONCLUSION

The Kannada version of APAIS is a valid and reliable tool for measuring preoperative anxiety in patients undergoing elective surgery.

Evaluation of Postoperative Pain After Cardiothoracic Surgery in Patients With and Without Significant Preoperative Anxiety: A Prospective Observational Study

BACKGROUND AND AIMS

Anxiety plays a distressing role in cardiothoracic operations. It may trigger hemodynamic instability, increased morbidity, and very crucially, postoperative pain and analgesic use. Our aim is to look at the association between anxiety, postoperative pain, and analgesic use.

MATERIALS AND METHODS

One hundred and twenty-two patients scheduled for cardiothoracic surgeries were asked questions according to the Amsterdam Preoperative Anxiety and Information Scale (APAIS), the evening prior to the surgery. Different factors that could affect anxiety perioperatively were recorded through the patient's hospital records. The visual analog score (VAS) was recorded at arrival in the ICU after surgery. Paracetamol (1 g) and Inj Tramadol (1 mg/kg) were administered as postoperative analgesia. Additional fentanyl boluses (1 mcg/kg) were administered whenever the VAS exceeded 4. Analgesic doses were documented. All the data were then analyzed statistically.

RESULTS

Preoperative anxiety was recorded in 63.9% of the 122 subjects included in the study, with younger patients and patients with very low socioeconomic status being the majority. VAS, at 20 and 24 hrs of assessment, was higher in both groups, and there was a statistically significant difference, with patients that were preoperatively anxious, recording higher VAS scores. Postoperative analgesic doses were also significantly higher for patients with anxiety.

CONCLUSIONS

This clinical trial demonstrated that greater than 60% of the participants presented with preoperative anxiety, the majority being young participants. Lower socioeconomic status is also a risk factor for preoperative anxiety. Patients who suffered from preoperative anxiety are more likely to have greater pain scores and analgesic needs during postsurgical assessment.

Psychological Discomfort in Patients Undergoing Coronary Artery Bypass Graft (CABG) in West Bank: A Cohort Study

Background/Objetives: Cardiovascular disease (CVD) remains a significant contributor to global morbidity and mortality rates. Coronary artery bypass graft (CABG) surgery is a critical intervention for patients with coronary artery disease, yet it poses psychological challenges that can impact recovery. Methods: This prospective cohort study, conducted across six hospitals in the West Bank/Palestine, aimed to assess changes in depression, anxiety, and stress levels among CABG patients and identify associated factors. The Arabic version of the Depression Anxiety Stress Scales (DASS-21) was administered before (one week) and after surgery (two and three weeks). Results: Of the 200 participants, 116 were men (58%). High levels of depression, anxiety, and stress were observed both before and after surgery, with statistically significant reductions in all these variables after surgery (p < 0.001). Regarding demographic factors, age displayed a weak positive correlation with depression (r = 0.283; p < 0.001), anxiety (r = 0.221; p = 0.002), and stress (r = 0.251; p < 0.001). Sex showed a weak correlation with stress pre-surgery (r = -0.160; p = 0.024). Conclusions: Patient outcomes could be improved by early identification and the provision of efficient treatments such as psychosocial therapy both before and after surgery.

Assessment of Preoperative Anxiety Levels Among Patients Admitted for Surgery in Public Hospitals, Southern Ethiopia

Background

Anxiety before surgery is one of the most challenging aspects of preoperative care. Preoperative anxiety has a number of postoperative complications. There are only a few studies that report on preoperative anxiety in surgical patients in Ethiopia, and their prevalence differs from one study to the next.

Objective

The aim of this study was to assess the level of preoperative anxiety and associated factors among surgical patients admitted at public hospitals in southern Ethiopia.

Methods

From July to August 2022, a facility-based cross-sectional study was conducted among patients admitted to surgical wards at public hospitals. Data collection was conducted using a pretested, structured questionnaire administered by an interviewer. Preoperative anxiety was assessed using the State-Trait Anxiety Inventory scale. The data were coded and entered in Epi Data Version 4.6, then exported to Statistical Package for Social Sciences version 25 for analysis. To describe the study variables, descriptive statistics were used. The associated factors were then identified using bivariate and multivariate logistic regression analyses. Results were declared at a p-value of less than 0.05 based on an adjusted odds ratio with a 95% confidence interval.

Result

A total of 220 patients were enrolled, with a 99.5% response rate. The observed preoperative anxiety level was 57.5% (95%CI: 54.63-62.35). High preoperative anxiety was associated with no formal educational status (AOR: 3.75; 95%CI = 1.36, 10.39), fear of death (AOR =2.01; 95%CI = 1.09, 3.73), fear of waking up in middle of surgery (AOR =3.42; 95%CI =1.19, 9.77), fear of postoperative pain (AOR = 2.56; 95%CI = 1.15, 5.74).

Conclusion

This study found that five out of ten patients scheduled for surgery in public hospitals had high levels of preoperative anxiety. Anxiety levels were associated with factors such as the educational status of respondents, fear of death, fear of waking up in the middle of surgery, and fear of postoperative pain. Preoperative anxiety assessments should be conducted regularly in each hospital, and appropriate anxiety-reducing methods must be implemented.

Prevalence of pre-operative anxiety and associated risk factors among patients awaiting elective surgery in a tertiary care hospital

Background

Patients undergoing surgery have a fear of anesthesia and surgical procedures that results in anxiety. The global incidence of pre-operative anxiety is estimated at 60-92%. Age, gender, education, marital status, type of family, type of anesthesia and surgery, and history of surgery are the contributing factors. High levels of anxiety during the pre-operative period has negative impacts on surgical outcomes. The main objective of this study was to find out the prevalence of pre-operative anxiety and associated risk factors in a hospital setting of a developing country.

Methods

This was a single center, analytical, cross-sectional study conducted among the admitted patients scheduled for elective surgeries in a tertiary care hospital. Non-probability convenience sampling was adopted and a total of 205 cases were included. The researchers themselves collected the data on the day before surgery using questionnaires comprised of two parts: semi-structured questionnaires prepared via literature review and Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Data were analyzed in SPSS version 23. Bivariate and multivariate analyses were performed appropriately.

Results

The prevalence of pre-operative anxiety was 25.85%. The median anaesthesia related, surgery related, and total anxiety scores were 4.00, 5.00 and 9.00 respectively. Likewise, the median score of information desired component scale was 5.00. Different anxiety scores were positively correlated with the information desire component score. The patients living in a nuclear family (adjusted OR, 2.480; 95% CI, 1.272-4.837, p = 0.008) and those without past history of surgery (adjusted OR, 2.451; 95% CI, 1.107-5.424, p = 0.027) had approximately 2.5 times higher risk of having pre-operative anxiety compared to those from a joint family and those having past history of surgery respectively. Those receiving spinal anesthesia had approximately two times lower risk of anxiety (adjusted OR, 0.511; 95% CI, 0.265-0.985, p = 0.045).

Conclusions

One fourth of the patients had pre-operative anxiety. Type of family, type of anesthesia and past history of surgery were found to be the independent predictors of anxiety.

Preoperative anxiety and associated factors among adult surgical patients in public hospitals, eastern Ethiopia

Objective

This study aimed to assess the prevalence of preoperative anxiety and associated factors among adult surgical patients in public hospitals of eastern Ethiopia from 25 April to 26 May 2022.

Methods

An institutional-based cross-sectional study was undertaken using a systematic sampling technique among 423 participants from patients eligible for elective surgery. The prevalence of preoperative anxiety was assessed using the state and trait anxiety inventory measurement scale. Data were analyzed using SPSS version 26. Descriptive and summary statistics were computed. Binary and multivariable logistic regression were computed. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and statistical significance was declared at a p-value < 0.05.

Results

The prevalence of preoperative anxiety among patients scheduled for elective surgery was 51.2%. Being 31-45 aged adult (AOR = 0.36; 95% CI = 0.17, 0.78), having moderate (AOR = 0.46; 95% CI = 0.22, 0.96) and strong social support (AOR = 0.04; 95% CI = 0.02, 0.08), being single (AOR = 0.19; 95% CI = 0.04, 0.89), listening to music (AOR = 0.37; 95% CI = 0.18, 0.74) and finding social and religious support (AOR = 0.15; 95% CI = 0.07, 0.33), and orthopedic surgery (AOR = 0.21; 95% CI = 0.10, 0.43) were significantly associated with lower odds of preoperative anxiety, whereas having fear of death (AOR = 1.16; 95% CI = 0.64, 2.09) was significantly associated with increased odds of preoperative anxiety.

Conclusion

In the current study, the magnitude of preoperative anxiety was high. Being an older adult and having social and treatment support was associated with lower odds of preoperative anxiety. In contrast, lower psychological readiness (fear of death) was associated with increased odds of preoperative anxiety. Patients should be routinely assessed for anxiety during the preoperative appointment, and the proper coping mechanisms and anxiety-reduction approaches should be used. It is also advisable that appropriate policies and procedures for reducing preoperative anxiety should be devised.

Psychometric evaluation of Urdu-translated Amsterdam preoperative anxiety and information scale and assessment of preoperative anxiety in adult surgical patients of Karachi, Pakistan: A cross-sectional study

Objective

The primary aim of this study was to develop an Urdu-translated version of the Amsterdam preoperative anxiety and information scale and perform a psychometric evaluation of it. A secondary aim was to estimate the prevalence of preoperative anxiety using Urdu-translated Amsterdam preoperative anxiety and information scale in patients undergoing surgery in Karachi, Pakistan, and the factors contributing to anxiety among them.

Method

This cross-sectional survey included 267 patients enrolled for elective surgery under general anesthesia from March 5 to November 20, 2022. In psychometric analysis, face validity, criterion validity, construct validity, and reliability of Urdu-translated Amsterdam preoperative anxiety and information scale were determined. Face validity was evaluated by performing blind-back translation and a pilot study. Criterion validity was evaluated by correlating the Amsterdam preoperative anxiety and information scale with the visual analog scale for anxiety. Exploratory factor analysis and Cronbach's α test were used to analyze construct validity and reliability, respectively. The associate variables were identified by performing a one-sample t-test and one-way analysis of variance on SPSS 26.

Results

Cronbach's α test is 0.85 for the Amsterdam preoperative anxiety and information scale anxiety scale and 0.70 for the need for information. 65.3% of the total variance is explained by the Urdu version of Amsterdam preoperative anxiety and information scale items in factor analysis and the intercorrelation of all items was >0.20 (mean: 0.575). Urdu-translated Amsterdam preoperative anxiety and information scale and visual analog scale for anxiety showed a good correlation (r = 0.664, p < 0.001). The overall prevalence of preoperative anxiety among patients is 52.4% suggested by the Amsterdam preoperative anxiety and information scale cutoff score of more than 11. Females, students, and patients elected for major surgery shared significantly higher anxiety levels (p < 0.05). The commonest factors contributing to anxiety are postoperative pain in 140 (52.4%) patients, fear of death in 115 (43.1%), and financial loss in 91 (34.1%).

Conclusions

The Urdu-translated Amsterdam preoperative anxiety and information scale is a reliable, valid, and acceptable screening tool for preoperative anxiety. The prevalence of preoperative anxiety was high. The preoperative anxiety level is significantly associated with gender, employment status, and type of surgery.

Describing and Predicting Preprocedural Anxiety in Patients Scheduled for Advanced Gastrointestinal Endoscopy During the COVID-19 Pandemic

Advanced gastrointestinal endoscopy includes a group of specialized procedures and interventions that are being performed more frequently, with little attention given to a patient's preprocedural anxiety issues. Compounding this concern, in 2020 the COVID-19 pandemic resulted in the delay of many endoscopy cases. It is unknown how this affected the anxiety of patients preparing for advanced endoscopy procedures. Patients with higher anxiety require higher doses of anesthetic medications, and experience increased pain and decreased satisfaction. The purpose of this study was to describe the biological, psychological, and social attributes of patients and identify whether social support, COVID-19-related anxiety, delay of procedure, patient's physical status, and procedural indication category were predictors of state anxiety levels in patients undergoing advanced gastrointestinal endoscopy during the COVID-19 pandemic. The research study was a cross-sectional descriptive design with 90 patients. Patients were classified into low state and high state anxiety groups. Fifty-eight percent of patients had high state anxiety scores. Using logistic regression, social support was identified as a predictor of preprocedural anxiety (odds ratio [OR] = 0.318 [95% confidence interval, CI = 0.170, 0.597, p < .001]) as less social support was associated with higher anxiety. It is imperative that strategies to maximize social support are reinforced.

Objective Assessment of Perioperative Anxiety using Functional Near-infrared Spectroscopy in Elderly Patients: A Prospective Randomized Observational Pilot Study

Background: Assessing and managing patient anxiety is essential to reduce postoperative complications in elderly patients. However, monitoring patient anxiety objectively is impossible. This study aimed to investigate the correlation between the level of fNIRS signals and anxiety in patients aged 65 and older undergoing artificial joint replacement surgery. Material and Methods: Sixty patients aged ≥65 years scheduled for elective total knee arthroplasty under spinal anesthesia were included. To differentiate the degree of anxiety, the patients were randomly divided into three groups, each consisting of 20 patients (group 1: administered normal saline as a placebo; groups 2 and 3: administered dexmedetomidine at a rate of 0.2 and 0.5 μg/kg/h, respectively, for 10 min). Functional near-infrared spectroscopy was measured continuously for 10 min in each session (session 1: pre-anesthetic period; session 2: immediately after the spinal anesthesia period; session 3: normal saline or dexmedetomidine receiving period) in all patients. Vital signs were measured thrice at 5-min intervals during each session. State-Trait Anxiety Inventory -S (STAI-S) and Ramsay Sedation Scale (RSS) scores were assessed at the end of each session. Results: The STAI-S score was significantly correlated with power of bandwidth (p = 0.034). In addition, the RSS score was significantly correlated with BW 1, 2, and 3 (p = 0.010, p < 0.001, and p = 0.003, respectively). Conclusion: The STAI-S score and BW 3 were significantly correlated, suggesting that fNIRS might help objectively and directly monitor anxiety levels.

Preoperative anxiety and associated factors among women admitted for elective obstetric and gynecologic surgery in public hospitals, Southern Ethiopia: a cross-sectional study

BACKGROUND

Preoperative anxiety is a major mental health problem during the preoperative period. Admission of women to surgery is stressful, and a high level of anxiety was associated with increased perioperative morbidity and mortality, poor treatment satisfaction, and bad obstetric outcomes, including long-term cognitive impairment in children. Despite its negative consequences, little is known on this area, particularly in the study area.

OBJECTIVE

To assess preoperative anxiety and associated factors among women admitted for elective obstetrics and gynecologic surgeries in public hospitals in Southern Ethiopia, 2022.

METHODS AND MATERIALS

An institution-based cross-sectional study design was conducted among 389 women using structured interviewer-administered samples who were selected by systematic random sampling from May 20th to June 20th, 2022. The Amsterdam preoperative anxiety and information scale (APAIS) was used to assess the level of anxiety. Data were collected electronically using the Open Data Kit version 2022.2.3 and analyzed with the Statistical Package for Social Sciences version 26.0. Bivariate and multivariable logistic regression analyses were done. The strength of the association was declared by using an adjusted odds ratio (AOR) with a 95% confidence interval, and a statistical significance of P < 0.05.

RESULTS

The magnitude of preoperative anxiety was 57.1% (95% CI = 51.4-61.5), and 48.1% of women required an average amount of information. Being a gynecologic patient (AOR = 2.0, 95% CI = 1.21, 3.32), having previous anesthesia and surgery (AOR = 2.09, 95% CI = 1.10, 3.96), having fear of postoperative pain (AOR = 1.96, 95% CI = 1.08, 3.53), having concern for family (AOR = 2.56, 95% CI = 1.49, 4.37), having poor social support (AOR = 3.75, 95% CI = 1.99, 7.09), and moderate social supports (AOR = 3.27, 95% CI = 1.74, 6.17), and having a high information requirement about anesthesia and surgery (AOR = 4.68, 95%CI = 2.16, 10.13) were statistically associated with preoperative anxiety.

CONCLUSION

Preoperative anxiety was often high in the region. Associated factors were the type of surgery, previous anesthesia and surgery, fear of postoperative pain, fear for family, social support, and a high information need. So the national and regional health bureau should develop guidelines and implement strategies to reduce women preoperative anxiety as part of midwifery care. The women should be assessed regularly during the preoperative visits; and appropriate anxiety reduction and information regarding surgery, and anesthesia should be provided.

Prevalence and factors associated with surgery anxiety in hospitalized patients: a point-prevalence study

BACKGROUND

Preoperative anxiety is a challenging problem in the preoperative care of patients. Identifying risk factors helps nurses provide psychological support during the pre-operative visit so that stress can be reduced.

AIMS

This study aimed to determine the prevalence of surgical anxiety and related factors in hospitalized surgical patients.

METHODS

This research was designed as a point-prevalence study. The study was completed with 223 patients hospitalized in the surgical clinics of a tertiary hospital in Turkey. Surgical anxiety questionnaire (SAQ) and State-trait anxiety inventory (STAI) were used for the assessment of anxiety.

RESULTS

Preoperative anxiety prevalence was 69.5% according to the SAQ and 49.3% according to STAI. Women, participants with no primary school education, those who were unemployed and had low income, those with no previous surgery, those living in fear of surgery, the participants who underwent major surgery and general anesthesia, and those who did not have knowledge about the surgical procedure and anesthesia had higher anxiety according to the two scales. A highly significant and positive correlation was found between total STAI and total SAQ.

CONCLUSION

The importance of surgical anxiety for the health system, which affects two out of every three hospitalized patients, should not be underestimated. Therefore, national and global plans should be made to prevent and manage surgical anxiety.

Preoperative anxiety and need for support - A qualitative analysis in 1000 patients

OBJECTIVES

Preoperative anxiety is prevalent, emotionally distressing for many patients, and can have harmful effects on postoperative outcomes. Despite its high prevalence, there has been little research on preoperative anxiety using qualitative methods. This study's main goal was to qualitatively examine factors that may contribute to preoperative anxiety in a large sample.

METHODS

In a survey, a total of 1000 patients awaiting surgery were asked open questions i) about reasons which they associate with their preoperative anxiety and ii) which coping strategies they would prefer in addition to premedication.

RESULTS

The qualitative analysis indicated five overarching domains, 16 themes, and 54 subthemes of preoperative anxiety. Intra- or postoperative complications was the most common theme regarding preoperative anxiety (n = 516). Personal conversation was the most frequently desired supportive measure in addition to premedication.

CONCLUSIONS

This study indicated a considerable heterogeneity of reasons associated with preoperative anxiety based on an unbiased assessment in a large sample. The study further suggests that a personal conversation is a clinically important coping strategy in addition to premedication.

PRACTICE IMPLICATIONS

Providers should assess patients' preoperative anxiety and the resulting need for support individually to offer supportive measures adapted to the patients' needs.

A Cross-Sectional Study of Factors Influencing Pre-Operative Anxiety in Orthognathic Patients

Orthognathic treatment is an important treatment modality to manage severe dentofacial discrepancies. Patients awaiting orthognathic surgery often experience increased anxiety, which may adversely affect post-operative recovery and treatment satisfaction. This study investigated the effects of a number of factors on pre-operative anxiety in orthognathic patients. Seventy patients prospectively recruited from three orthognathic centres in the UK completed a pre-operative questionnaire that included validated scales for measuring anxiety, social support, resilience, and coping styles. Sociodemographic data and satisfaction with the information provided by the clinical team were also elicited from the questionnaire. Univariable analysis showed that social support from a significant other (p = 0.026), resilience (p < 0.001), and satisfaction with the information provided by the clinical team (p = 0.002) were significantly associated with reduced anxiety, whilst avoidance coping (p < 0.001) and coping through seeking social support (p = 0.006) were significantly related to increased anxiety. With the exception of coping by seeking social support, these relationships retained significance in a multivariable regression analysis. Neither gender nor ethnicity moderated the effects of social support on pre-operative anxiety. These findings suggest potential avenues for clinicians to address with future interventions to reduce pre-operative anxiety. Further qualitative research may provide greater clarity on the relationship between these variables and anxiety.

[Perioperative anxiety and fear of death]

An important field of anesthesiology but also of psychiatry and psychotherapy, is perioperative anxiety and especially the fear of death. In this review article the most important types of anxiety in the individual phases before, during and after surgery are presented and diagnostic aspects as well as risk factors are discussed. Benzodiazepines can classically be used therapeutically here, but in recent years the preoperative anxiety-reducing effects of e.g., supporting talks, acupuncture, aroma therapy, and relaxation methods have come more into focus, because benzodiazepines promote postoperative delirium, which significantly increases morbidity and mortality. Perioperative fear of death should, however, be given greater clinical and scientific attention in order not only to have a better understanding and preoperative care of patients, but also to reduce adverse consequences during surgery and afterwards.

Turkish Validity and Reliability Study of the Surgical Anxiety Questionnaire for Adult Patients

PURPOSE

This research aims to adapt the Surgical Anxiety Questionnaire (SAQ) to Turkish culture and conduct validity and reliability studies.

DESIGN

This research is a methodological study.

METHODS

The sample of the research consisted of 311 patients and research data were collected between April 2019 and May 2021.

FINDINGS

The scale content validity index was 0.931. As a result of the factor analysis, the items were distributed in four subdimensions and explained 58.745% of the variance, and the model had good fit values. The Cronbach's α coefficient of the scale was 0.890.

CONCLUSIONS

The Turkish version of SAQ is a valid and reliable measurement tool and can be used for adult patients.

Public Awareness and Knowledge About Anesthesiology and the Role of Anesthesiologists in Al-Qassim Province, Saudi Arabia

Introduction Anesthesiology is a specialty of medicine that focuses on inducing reversible loss of consciousness, amnesia, muscle relaxation, and analgesia. Anesthesiologists play an important and integral role in pain clinics, operating rooms, and intensive care units (ICU). This study assessed public awareness and knowledge about the specialty of anesthesiology and the role of anesthesiologists in Qassim province, Saudi Arabia. Methods An observational, cross-sectional study was conducted in Qassim province from September 2022 to December 2022. A modified electronic questionnaire was distributed through social media platforms. The questionnaire contained items designated as demographics, knowledge, and experience regarding anesthesia and the importance of anesthesiologists. Saudi participants older than 18 years of age were eligible to complete the survey. Results Of the 405 participants, 375 met the inclusion criteria (48.5% women and 51.5% men), and participants with an undergraduate education level (23.5%, p<.05) had a higher prevalence of having undergone surgery previously. Furthermore, it was found that factors, such as knowledge about the complications of regional anesthesia (p<.001) positively influenced anesthesia knowledge. Moreover, in a linear regression model, an understanding of the complications of regional anesthesia was associated with increased anesthesia knowledge (p<.05). However, the sample demonstrated a poor level of anesthesia knowledge, evidenced by the responses to questions assessing the same. Conclusions Consistent with the literature, there was a poor level of anesthesia awareness and knowledge among the adult population living in Saudi Arabia. Further research is needed to establish the link between anesthesia awareness, knowledge about the role of the anesthesiologist, and knowledge about anesthesiology in the region.

Preoperative Patient Education Practices and Predictors Among Nurses Working in East Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022

Background

The time before surgery is a traumatic period for patients. Despite this fact, no research has been conducted on nurses' preoperative patient education in Ethiopia. This study aimed to assess preoperative patient education practices and associated factors among nurses working in East Amhara comprehensive specialized hospitals, Ethiopia, 2022.

Methods

A hospital-based cross-sectional study was conducted with 416 nurses. Pretested, structured questionnaires were used to collect the data. Bivariable analysis was performed for each independent variable with a P-value < 0.25 on the data imported to multivariate logistic regression analysis. AOR with a 95% CI and a P-value < 0.05 at a 5% level of significance were considered.

Results

Only 38.5% of nurses were found to have good practices for preoperative patient education, with a response rate of 98%. Nurses with 6 years of work experience (AOR = 3.15, 95% CI: 1.692-5.874), adequate time (AOR = 2.33, 95% CI: 1.119-4.889), training (AOR = 4.27, 95% CI: 1.548-11.796), age 25-29 (AOR = 0.15, 95% CI: 0.070-0.331), age 30-34 (AOR = 0.25, 95% CI: 0.137-0.479), and knowledge (AOR = 3.73, 95% CI: 2.222-6.273) were significantly associated.

Conclusion

Preoperative patient education practices among nurses were poor. Work experience, knowledge, training, and adequate time were found to be significant. Organize preoperative patient education programs for nurses that share experiences and provide ongoing training.

Impact of Virtual Operating Room Tours on Relieving Perioperative Anxiety in Adult Patients: A Systematic Review

PURPOSE

To evaluate the effects of virtual operating room tours on perioperative anxiety in adult patients.

DESIGN

This study was a systematic review of randomized controlled trials (RCTs).

METHODS

PubMed, Cochrane Library, Embase, Web of Science, Proquest, Scopus, SinoMed, CNKI, and WanFang were systematically searched for English and Chinese RCTs published up to November 18, 2021, for studies on the effectiveness of virtual operating room tours in reducing perioperative anxiety in adult patients (>18 years of age). Primary and secondary outcomes were perioperative anxiety levels and understanding level of perioperative information and patient satisfaction, respectively. The data were synthesized using a qualitative method.

FINDINGS

Five studies were found eligible for inclusion; 3 studies showed a significant decrease in perioperative anxiety levels in patients of the virtual operating room tours group. Furthermore, the overall satisfaction, understanding of perioperative information, and preoperative preparedness were significantly enhanced respectively in 3 studies.

CONCLUSIONS

This study showed the effectiveness of virtual operating room tour on alleviating perioperative anxiety on adult patients. Furthermore, the satisfaction and understanding of perioperative information in intervention group improved owing to these tours. Future quantitative studies are needed to support these findings.

Effects of Earmuffs and Eye Masks on Propofol Sedation during Spinal Anesthesia for Orthopedic Surgery: A Randomized Controlled Trial

Intravenous sedative drugs are commonly administered during regional anesthesia. However, reducing the excessive use of sedatives while providing adequate sedation is important from the clinical perspective, since the use of sedatives can cause considerable complications. We hypothesized that the application of earmuffs and eye masks would help reduce the sedative dose required to maintain proper sedation by blocking external stimuli. Patients who underwent orthopedic surgery under spinal anesthesia were randomly allocated to the control (no intervention) or intervention group (wearing earmuffs and eye masks). Intravenous sedation was administered using target-controlled infusion of propofol. The target concentration was controlled to maintain a Modified Observer's Assessment of Alertness and Sedation score of 3 or 4. The primary outcome was the intraoperative propofol requirement. We also investigated the incidence of apnea, and patient satisfaction. Propofol requirement was significantly lower in the intervention group than that in the control group (2.3 (2.0-2.7) vs. 3.1 (2.7-3.4) mg·kg^-1·h^-1; p < 0.001). Intraoperative apnea occurred less frequently (p = 0.038) and patient satisfaction was higher (p = 0.002) in the intervention group compared to the control group. This study demonstrated that the use of earmuffs and eye masks during sedation was associated with lower propofol requirement and improved sedation quality.

Satisfaction and tolerability using virtual reality (VR) as adjunctive treatment during flexible bronchoscopy: a randomized control trial

BACKGROUND

Patient comfort during invasive and therapeutic procedures is important. The use of virtual reality (VR) devices during flexible bronchoscopy (FB) as a method of distraction to increase patient tolerability and improve satisfaction has not been investigated. We aim to assess the satisfaction and tolerability of participants undergoing FB with or without VR.

METHODS

This was a single-center, open-label study on patients undergoing bronchoscopy, randomized into the control and interventional (VR) groups. The control group received standard care during FB. The interventional group was given a VR device during FB showing nature videos with soothing instrumental music. Pain, breathlessness, and cough were evaluated using a 10 cm visual analogue scale administered before and after FB. Anxiety was assessed using the State-Trait Anxiety Inventory. Satisfaction questionnaire (5-point Likert scale) was given to participants post FB.

RESULTS

Eighty participants enrolled, 40 in each arm. Median (IQR) satisfaction score in the VR group was 5.0 (3.0-5.0), and in the control group was 4.0 (3.0-5.0); (p < 0.001). Breathlessness, cough, and anxiety post FB were significantly less severe in the interventional group (p = 0.042, p = 0.001, p < 0.001), but the pain was not significantly different (p = 0.290).

CONCLUSION

VR used during FB led to better participants' satisfaction and tolerability (breathlessness and cough). There was a significantly lower anxiety score in the VR group.

A Systematic Review of Heart Rate Variability as a Measure of Stress in Medical Professionals

Understanding the physiological effects of responding to crises is a critical component in understanding how to manage and prepare medical professionals to be crisis responders. Heart rate variability (HRV) is the variation in rate between a succession of R-R intervals. This variation is not only affected by physiological processes such as respiration or metabolic rate but is also directly controlled by the autonomic nervous system. As such, heart rate variability has been proposed as a noninvasive tool to measure the physiological stress response. The aim of this systematic review is to consolidate heart rate variability literature in the context of medical emergencies to determine if heart rate variability changes predictably from baseline when responding to medical crises. This may demonstrate utility as an objective, noninvasive measure of stress response. A systematic literature review of six databases yielded 413 articles, 17 of which met our inclusion criteria of being written in English, measuring HRV in healthcare providers, and measuring HRV in real or simulated medical resuscitations or procedures. Articles were then analyzed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. Out of the 17 articles reviewed, 11 demonstrated statistically significant results showing heart rate variability responding in a predictable manner to stress. Three articles utilized a medical simulation as the stressor, six used medical procedures, and eight used medical emergencies encountered during clinical work. Overall, a predictable trend in heart rate variability metrics of standard deviation from the mean value of normal-to-normal (N-N) intervals (SDNN), root mean square of the successive differences (RMSSD), mean number of times per time interval in which the change in successive normal sinus (N-N) intervals exceeds 50 ms (PNN50), low frequency % (LF%), and low-frequency-to-high-frequency ratio (LF/HF) was observed when responding to stress. This systematic literature review showed that heart rate variability among healthcare providers responding to stressful scenarios follows a predictable pattern of change and expands our understanding of the physiology of stress in healthcare providers. This review supports the use of HRV to monitor stress during high-fidelity simulation to ensure that appropriate physiological arousal is achieved during the training of medical personnel.

Preoperative anxiety during COVID-19 pandemic: A single-center observational study and comparison with a historical cohort

Background

Preoperative anxiety is a common sensation experienced by patients undergoing surgical interventions. It can influence intraoperative and postoperative management through the activation of the neuroendocrine system, leading to tachycardia, hypertension, pulmonary complications, higher consumption of anesthetic drugs, and increased postoperative pain. Our aim was to investigate the level of preoperative anxiety during the COVID-19 pandemic; we also compared it to the preoperative anxiety of a historical cohort before the outbreak.

Methods

This is a single-center observational study. We enrolled 314 patients during the pandemic from May 2021 to November 2021, and our historical cohort consisted of 122 patients enrolled from July 2015 to May 2016 in the university hospital "Federico II" of Naples. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory (STAI) were used to evaluate preoperative anxiety. In particular, APAIS measures preoperative anxiety and the need for information, and STAI assesses state and trait anxiety through STAI-Y1 and STAI-Y2, respectively. We analyzed APAIS and STAI scores in our population stratified on the basis of age, gender, marital status, previous surgical experiences, and type of surgery, and we compared them to our historical cohort. Statistical analysis was performed through a t-test and ANOVA for parametric data, and the Mann-Whitney and Kruskal-Wallis tests for non-parametric data. Linear regression was used to investigate the correlation between demographic data and the scores of STAI and APAIS in both groups.

Results

Our results showed that state and preoperative anxiety remained stable, whereas trait anxiety increased in all the subgroups analyzed.

Discussion

Even if state anxiety is considered a variable characteristic of the emotional sphere and trait anxiety a stable element, our findings suggested that COVID-19 deeply influenced trait anxiety, thus altering the patients' psychological foundations.

The effectiveness of using virtual reality technology for perioperative anxiety among adults undergoing elective surgery: a randomised controlled trial protocol

BACKGROUND

More than 2.5 million people are admitted for surgery in Australia each year, and between 40 to 80% will experience moderate to high preoperative anxiety. Elevated levels of preoperative anxiety can increase the risk of postoperative complications such as pain, delayed wound healing, infection, prolonged recovery, and longer hospitalisation. Limited previous research on Virtual Reality (VR) indicates a positive impact on surgery-related anxiety and suggests that the intervention potentially leads to reduce postoperative complications.

OBJECTIVE

To evaluate the effectiveness of using VR technology for perioperative anxiety among adults undergoing elective surgery.

METHOD

A two-group parallel randomised controlled trial (RCT) will be conducted, including 150 adult patients (aged 18 years and over) undergoing elective surgery and requiring an overnight stay at a major metropolitan hospital. Eligible participants will be screened for anxiety via the Amsterdam Preoperative Anxiety and Information score (APAIS). Those with moderate to severe anxiety will be randomly allocated to receive the VR session or usual care, in the preoperative holding area. Intervention participants will use a head-mounted VR device to watch and listen to a nature scene for 10 minutes.

STUDY OUTCOMES

The primary outcome is perioperative anxiety measured using the visual analogue scale for anxiety (VAS-A). Secondary outcomes include stress levels (measured by saliva cortisol level and heart rate), postoperative pain, patient satisfaction with perioperative care, hospital length of stay, and VR-associated adverse events.

CONCLUSION

This study will help evaluate if a brief preoperative VR session can reduce perioperative anxiety for adult elective surgical patients.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001350910.

Relationship between Psychological Distress and Demographic Characteristics among Patients Undergoing Coronary Artery Bypass Graft (CABG) Surgery

Coronary artery bypass graft (CABG) surgery patients often present with anxiety and depression. These symptoms coupled with pain are major concerns and are widely reported among CABG patients. The study aimed to evaluate the relationship between psychological distress and patients’ demographic data. This cross-sectional study in which 178 patients from a surgery ward were selected using the census method. Data were collected using the Hospital Anxiety and Depression Scale and the Brief Pain Inventory (Short Form). The participants’ mean age was 57.49 ± 13.78 years. The majority of participants had a moderate level of anxiety (89.3%) and a moderate level of pain interference (74.7%). Significant differences were noted, with a higher proportion of moderate anxiety level participants aged between 60 and 74 years old, married, and with a tertiary level education (p < 0.05) being found. There were also significant differences between gender (p < 0.05) and pain severity (p < 0.01) across the levels of depression. The levels of anxiety, depression, and pain were significant, especially among older patients. These symptoms should be routinely assessed, and further identification of predictors such as socioeconomic status before the procedure is necessary.

Effect of video-based information on preoperative State trait anxiety inventory scores in adult patients presenting for elective caesarean section: a randomized controlled trial

Background

Preoperative anxiety is a common occurrence in patients presenting for surgery with a reported incidence of up to 80%. Increased preoperative anxiety has been associated with increased morbidity. Provision of information relating to surgery and anaesthesia to patients has been proven to have benefit in allaying anxiety. However, the best format of information dissemination remains unknown.

Objective

To determine the effect of video information in addition to the pre-anaesthetic review on the mean preoperative State anxiety inventory (STAI-S) score in adult patients presenting for elective caesarean section under spinal anaesthesia at Aga Khan University Hospital, Nairobi (AKUHN), and to determine the prevalence of preoperative anxiety in the obstetric population presenting for elective caesarean section at AKUHN.

Methods

Thirty-seven adult patients booked for elective caesarean section under spinal anesthesia were randomly assigned to one of two groups. In the study arm; a video was shown to the participants in addition to the standard pre-anaesthetic review. In the control arm the participants only had a standard pre-anaesthetic review.

Results

The mean STAI-T score in the sampled population was 45.64 (SD 5.625). The mean baseline STAI-S score was 46.32 (SD 4.911). There was no statistically significant difference in change in STAI score between the video and control arms (p>0.05).

Conclusion

On the basis of this study among this population, there was no benefit demonstrated from the use of an information video about spinal anaesthesia on anxiety levels in obstetric patients presenting for a first time spinal.

Preoperative anxiety and its associated factors among women undergoing elective caesarean delivery: a cross-sectional study

BACKGROUND

Anxiety is a behavioral expression of tension and unpleasant emotion that arises from multifactorial dimensions that might increase the mortality of patients during anesthesia and surgery. This study aimed to verify the prevalence and associated factors of preoperative anxiety among women undergoing elective cesarean delivery.

METHOD

A cross-sectional study design was conducted on a total of 392 patients who underwent elective cesarean delivery in Debre Tabor Comprehensive Specialized Hospital, in North Central Ethiopia from October 15, 2020, to September 15, 2021. Data was collected using a validated Amsterdam questionnaire, after translating to the local language (Amharic). Descriptive statistics were expressed in percentages and presented in tables. Bivariable and multivariable logistic analyses were done to identify factors associated with preoperative anxiety. The statistical significance level was set at P < 0.05 with 95% CI.

RESULTS

The overall prevalence of preoperative anxiety in women undergoing elective cesarean delivery was 67.9 [95% CI = (63.0-72.7)]. Participants who came from rural areas [AOR = 2.65; 95%CI: 1.27-5.53], farmers [AOR = 2.35; 95%CI: 1.02-5.40], participants with no previous surgical and anesthesia history [AOR = 2.91; 95%CI: 1.69-5.01], and primiparous women [AOR = 1.69; 95%CI: 1.01-2.83] were more significantly associated with preoperative anxiety.

CONCLUSION

The prevalence of preoperative anxiety among elective cesarean deliveries was found to be high. So, preoperative maternal counseling and anxiety reduction services should therefore be given top priority, particularly for those women who came from rural areas, are farmers, have no prior surgical or anesthetic experience, and are primiparous.

The overlooked problem among surgical patients: Preoperative anxiety at Ethiopian University Hospital

Introduction

Anxiety was repeatedly reported as the worst aspect of the perioperative time. The objective of this study was to assess the prevalence of preoperative anxiety among adult surgical patients at University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.

Methodology

A hospital-based cross-sectional study was conducted among surgical patients at the university hospital. After obtaining ethical approval, 407 surgical patients were approached during the preoperative period. Preoperative anxiety was assessed by State-Trait Anxiety Inventory. The association between variables was determined by using binary logistic regression analysis. Strength of association was described in adjusted odds ratio (AOR), and a p-value < 0.05 at 95% confidence interval was considered statistically significant.

Results

A total of 400 patients were included in this study with a 98.3% response rate. Preoperative anxiety was observed among 237 (59.3%) patients, and the median (IQR) STAI score was 50 (40-56.7); age, ≥ 60 years (AOR: 5.7, CI: 1.6-20.4, P: 0.007); emergency surgery (AOR: 2.5, CI: 1.3-4.7, P: 0.005); preoperative pain (AOR: 2.6, CI: 1.2-5.4, P: 0.005); and rural residency (AOR: 1.8, CI: 1.1-2.9, P: 0.031) were found significantly associated with preoperative anxiety.

Conclusion

The prevalence of preoperative anxiety among surgical patients was high. Older age (≥ 60 years), emergency surgery, preoperative pain, and rural residency were found significantly associated with preoperative anxiety. Assessment for preoperative anxiety should be a routine component of preoperative assessment of both elective and emergency surgical patients. Preoperative pain should be appropriately managed as it can help to reduce preoperative anxiety. Optimal anxiety reduction methods should be investigated and implemented in the hospital.

Magnitude of Preoperative Anxiety and Associated Factors Among Adult Surgical Patients in Debre Berhan Comprehensive Specialized Hospital

Background

Anxiety is an un-pleasurable emotional state associated with psychophysiological changes in response to an intra-psychic conflict. The perioperative period is one of the worrying events for most surgical patients. Despite preoperative anxiety having many negative consequences on post-operative physical and mental health, no adequate information on the degree to which the preoperative period exposed clients to preoperative anxiety and its associated factors.

Objective

To assess the prevalence of preoperative anxiety and associated factors among adult surgical patients in Debre Berhan Comprehensive Specialized Hospital, Ethiopia.

Methods

Institution-based cross-sectional study was conducted from June 1, 2020, to August 30, 2020. State-Trait Anxiety Inventory Scale (S-STAI) was used to measure the level of pre-operative anxiety. A systematic random sampling technique was employed to collect the data. The data were entered to Epi-Data version 4.6 and exported to SPSS version 25 for data analysis. A statistically significant association was declared at a p-value less than 0.05.

Results

A total of 330 patients were enrolled in the study with a response rate of 93.2%. The prevalence of a high level of preoperative anxiety was 53.6% (95% CI (49.6-58.7)). Being female 3.2 (2.19, 3.71) illiterate 4.1 (2.01, 15.39), fear of death 2.12 (1.30, 3.44), results of operation 2.60 (1.75, 4.18), postoperative pain 2.35 (1.37, 4.02), and surgical complication 1.9 (1.03, 12.13) were statistically significant factors.

Conclusion

Preoperative anxiety affects more than half of surgical patients which is a high and serious health burden. Additionally, this study revealed that being female, illiterate, fear of death, having a history of surgical complications and fear of complications, and fear of postoperative pain were significantly associated with preoperative anxiety. Assessing during the preoperative period helps to detect and ameliorate the problem. Preoperative counseling and informed consent taken as a prerequisite for surgery will help in reducing preoperative anxiety.

Early Mini-Invasive Treatment of Persistent Cervical Dysplasia: Clinical Outcome and Psycho-Relational Impact

Introduction

After the diagnosis of L-SIL, 77. 3% had a persistent infection and anomalous Pap Test results. Many of these patients had highlighted psychological consequences such as anxiety, hypochondria, fear of cancer, and sexual problems. Several studies suggested that the clearance of HR-HPV infection could be accelerated by cervical excisional procedures, especially in L-SIL. In consideration of the psychological implications for HPV infection and related dysplasia in patients with CIN1 at PAP-smear and HR-HPV positivity at least for 6 months, we decided to plan a prospective study where we tried to anticipate excisional cervical using a minimally invasive treatment: thin loop electrosurgical excision procedure (t-LEEP). This study aims to analyze the clearance of HR-HPV after 6 and 12 months, clinical outcomes related to t-LEEP, and the psycho-relational impact at 12 months after t-LEEP.

Materials and Methods

We enrolled patients with the diagnosis of L-SIL at PAP-smear and HR-HPV positivity with a persistent CIN 1 (at least for 6 months), confirmed by cervical biopsy. All enrolled patients underwent t-LEEP. We followed prospectively and performed for all patients the HPV DNA test at 6 (T1) and 12 months (T2) and STAI-Y and FSFI scores at T0 and T2.

Results

We prospectively enrolled 158 patients, 22 are excluded for the established criteria. Patients with HR-HPV and CIN 1 lesions treated with t-LEEP had an overall clearance of 83.8% at T2. In subgroups analysis at T2, we had a regression: in smoker 71.8%, in contraceptive users 69.5%, in patients aged &lt;25 years 100%, aged 25–30 years 85%, aged 30–35 years 94.4%, aged 35–40 years 92%, and aged ≥40 years 89.1%, in HPV-16 96.4%, in HPV-53 89.5%, in HPV-18 87.5%, in HPV-31 86.6%, and in coinfected 3.5%. STAI-Y and FSFI after t-LEEP (T2) were statistically significant, reducing anxiety status and improving sexual function.

Conclusion

Based on these results, the use of t-LEEP in patients with persistent CIN 1 and HPV-HR at least for 6 months could be useful for accelerating HPV-HR clearance, in particular, for a subpopulation patient with an increased risk of progression and/or patients with psychological and sexual consequences of carrying an HR-HPV infection.

Preoperative Anxiety among Adult Patients Undergoing Elective Surgeries at a Tertiary Teaching Hospital: A Cross-Sectional Study during the Era of COVID-19 Vaccination

Anxiety in the perioperative period has significant impact on both the flow of surgery and the post-operative recovery process. The aim of this cross-sectional study is to determine the prevalence of preoperative anxiety among adult patients undergoing elective surgical procedures at a tertiary teaching hospital and the effect of COVID-19 and COVID-19 vaccines on preoperative anxiety. We used the Amsterdam Preoperative Anxiety and Information Scale (APAIS) to assess patients’ anxiety toward surgery and their need for more information. Patients with APAIS about anesthesia and surgery (APAIS-A-T) total score <10 were considered as the low preoperative anxiety group, while patients with APAIS-A-T ≥11 were considered as the high preoperative anxiety group. The overall APAIS-A-T score of the 794 included patients was 8.5 ± 4.5. The mean APAIS-A-T score was 7.0 ± 3.8 among males and 9.6 ± 4.6 among female patients (p < 0.001). The APAIS-A-T score for those who had previously underwent surgery under anesthesia was 8.3 ± 4.4, compared to 9.5 ± 4.8 for those who had not (p = 0.002). No significant difference was found between those with a previous history of COVID-19 and those without (p = 0.105), nor between those who were vaccinated and those who were not (p = 0.550). Sixty-four (26.8%) highly anxious patients were afraid of becoming infected with COVID-19 during their hospital stay (p = 0.009). This fear of COVID-19 in-hospital transmission made 19 (7.9%) highly anxious patients and 36 (4.5%) of the total sample hesitant to undergo this surgery (p = 0.002). In conclusion, this study demonstrated that 30.1% of patients had high preoperative anxiety, with fear of pain after surgery being the most common factor related to anxiety on the day of surgery. Controlling the spread of COVID-19 can play a crucial role in decreasing preoperative anxiety during this pandemic.

Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis

OBJECTIVES

This review aimed to determine the pooled prevalence of preoperative anxiety and its associated factors among patients undergoing surgery in low/middle-income countries (LMICs).

METHODS

We searched PubMed, SCOPUS, CINAHL, Embase and PsychINFO to identify peer-reviewed studies on the prevalence and factors associated with preoperative anxiety among patients undergoing surgery using predefined eligibility criteria. Studies were pooled to estimate the prevalence of preoperative anxiety using a random-effect meta-analysis model. Heterogeneity was assessed using I² statistics. Funnel plot asymmetry and Egger's regression tests were used to check for publication bias.

RESULT

Our search identified 2110 studies, of which 27 studies from 12 countries with 5575 participants were included in the final meta-analysis. Of the total 27 studies, 11 used the State-Trait Anxiety Inventory to screen anxiety, followed by the Amsterdam Preoperative Anxiety and Information scale, used by four studies. The pooled prevalence of preoperative anxiety among patients undergoing surgery in LMICs was 55.7% (95% CI 48.60 to 62.93). Our subgroup analysis found that a higher pooled prevalence of preoperative anxiety was found among female surgical patients (59.36%, 95% CI 48.16 to 70.52, I2=95.43, p<0.001) and studies conducted in Asia (62.59%, 95% CI 48.65 to 76.53, I2=97.48, p<0.001).

CONCLUSION

Our meta-analysis indicated that around one in two patients undergoing surgery in LMICs suffer from preoperative anxiety, which needs due attention. Routine screening of preoperative anxiety symptoms among patients scheduled for surgery is vital.

PROSPERO REGISTRATION NUMBER

CRD42020161934.

Will a preoperative theatre visit reduce anxiety? A randomised controlled trial

To assess the effect of preoperative theatre visit in reducing anxiety and its associated adverse outcomes, a single centre randomised controlled trial was conducted at the Professorial Gynaecology Unit, Colombo South Teaching Hospital, Sri Lanka. 64 patients were randomised. The intervention group had a pre-operative theatre visit with an informative session regarding the surgery. Patients' anxiety before, at the time and after the surgery was assessed using APAIS score. Pre-induction parameters and pain score were also assessed. APAIS anxiety difference before the surgery and on the day of the surgery was -1.937 (±4.641) and -1.781 (±2.586) for the intervention and the control groups respectively (p = 0.643). There was no significant difference in pre-induction parameters between the groups. Pain score at 6 hours after surgery was 5.04 (±2.510) for the intervention group and 6.08 (±2.888) for the control (p = 0.189). Preoperative theatre visit prior to surgery made no significant difference in the patient's anxiety, though a trend in reduction of anxiety and pain was noted.Impact statementWhat is already known on this subject? Patients experience significant anxiety before surgical procedures and high levels of anxiety can lead to adverse outcomes needing high induction doses of aneasthesia, delayed recovery and more postoperative pain. Different methods for preoperative anxiety reduction such as provision of systematic preoperative instructions, cognitive-behavioural interventions had been successful.What do the results of this study add? There are only a limited number of studies conducted assessing the methods of informational interventions to reduce anxiety. Preoperative theatre visit is a simple intervention that can be carried out without any additional preparation.What are the implications of these findings for clinical practice and/or further research? Our study could not show that preoperative theatre visit as an effective intervention in reducing anxiety in patients undergoing elective gynaecological surgery. However, there was a trend towards reduction in anxiety and postoperative pain with the intervention. Future research on providing additional information at the preoperative visit, timing of the visit and larger sample sizes may reveal better outcomes.

"Prevalence and associated factors of preoperative anxiety among obstetric patients who underwent cesarean section": A cross-sectional study

Background

Anxiety is the most common problem in the preoperative period. This anxiety increases postoperative pain, delay healing, and prolong the hospital stay. Among the surgical population, a higher level of preoperative anxiety has been seen in obstetric patients.

Objective

The aim of this study was to assess the prevalence and associated factors of preoperative anxiety among obstetric patients undergoing cesarean section.

Methods

An institutional-based cross-sectional study was conducted from January 01, 2021, to May 30, 2021. A total of 376 obstetric patients who underwent cesarean sections were included. Descriptive statistics, cross-tabs, and binary logistic regression analysis were performed to identify the association shivering and independent variables. The strength of the association was presented using an adjusted odds ratio with a 95% confidence interval and a p-value<0.05 was considered as statistically significant state versions of state-trait anxiety inventory scale (S-STAI) were used for this study.

Results

The overall prevalence rate of preoperative anxiety was 63% (95% CI: 58.2, 68.1). The patient's preoperative mean anxiety score of STAI was (43.81 ± 8.81). There was a high level of preoperative anxiety in patients undergoing emergency cesarean section as compared to elective patients. Patients' age less than 30 years, level of education, and previous anesthesia and surgery exposure were also highly associated with the dependent variable.

Conclusion

In this study, fear of complications and fear of death result of operation were the most common factors responsible for preoperative anxiety while few patients were anxious about financial loss and osmotic issues.

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The prevalence rate of preoperative anxiety was 63% among obstetric patients.

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Preoperative anxiety was highly related to fear of complications and fear of death.

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Age, Level of education were significantly associated with preoperative anxiety.

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Previous anesthesia exposure was also significantly associated with anxiety.

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Preoperative anesthesia visits are important to reduce anxiety.