This cross-sectional, interviewer-administered questionnaire study examined determinants of preoperative anxiety (PA) with a specific focus on elements of preoperative surgical and anesthetic counseling, surgical technique and planned anesthesia. The research was performed between November 2023 and January 2024 at a single institute and is reported using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) as the primary outcome measure.
Adults aged 18 years or older who were booked for surgical procedures were eligible. Patients who declined or could not reliably complete the questionnaire or who had substantial missing data were excluded. Of 411 interviewed patients, 401 were included in the final analysis. The mean age of participants was 46.1 years (SD 15.8; range 18–98).
Data collection was interviewer-administered in the preoperative anesthesia clinic. The questionnaire comprised four sections: sociodemographic characteristics; surgical and anesthetic history; preoperative counseling characteristics; and the APAIS. The APAIS consists of six items—four assessing anxiety and two assessing information needs—scored on a 1–5 Likert scale. Total anxiety (surgery- plus anesthesia-related items) ranges 4–20; a total anxiety score ≥11 was used to define clinically significant (high) PA in this study.
The third section of the questionnaire captured counseling- and procedure-related factors that have been under-investigated in prior work. These included:
A priori sample size calculation indicated 382 patients would provide suitable precision for assessing determinants of PA. Data were analyzed with IBM SPSS v29. Continuous variables that were not normally distributed (age, duration of surgery, duration of consultations) were compared using the Mann–Whitney U test. Categorical variables were compared with chi-square or Fisher’s exact tests. Bivariate logistic regression identified candidate predictors for inclusion in multivariate logistic regression; collinearity diagnostics (Tolerance, VIF) were applied. A two-sided P value <0.05 was considered statistically significant.
The study found a prevalence of clinically significant preoperative anxiety of 39.7% among the 401 included patients. Mean age and other demographic descriptors were reported; demographic associations with PA included female sex, younger age and unemployment status.
In addition to demographic predictors, several counseling- and procedure-related factors were significantly associated with higher PA (P < 0.05):
Fewer preoperative surgical consultations were associated with higher anxiety.
Longer duration of each surgical consultation correlated with higher anxiety.
Undergoing laparoscopic procedures (compared with open surgery) was associated with higher anxiety.
Referral to an internist for further evaluation during the anesthesia assessment was associated with higher anxiety.
Use of general anesthesia, or patient uncertainty about the type of anesthesia, was associated with higher anxiety.
Use of illustrations and figures during consultations was unexpectedly associated with higher anxiety (P < 0.05).
The authors report these associations based on bivariate analyses and consideration in multivariate regression where appropriate.
Some variables that might be expected to influence PA did not show significant associations in this study:
The number of anesthetic consultations was not significantly associated with PA.
The surgeon’s level of experience was not significantly associated with PA.
Patient use of internet searches to obtain more information did not have an observable effect on PA.
This study corroborates previously reported demographic correlates of higher preoperative anxiety—female sex, younger age and unemployment—and identifies counseling- and procedure-related factors that may also influence anxiety levels. Notably, fewer preoperative surgical consultations and longer consultations, referral to an internist, planned general anesthesia or uncertainty about anesthesia, and undergoing laparoscopic rather than open surgery were associated with higher anxiety. The finding that use of illustrations during counseling correlated with higher anxiety is unexpected and suggests that certain explanatory approaches may not uniformly reduce anxiety.
The authors conclude that PA remains a significant perioperative concern and that these identified factors could inform focused interventions to reduce anxiety and potentially improve perioperative satisfaction and outcomes. The paper reports that data and supporting information are available within the article and its supporting files. Details on the magnitude of effect estimates, the multivariate model coefficients and potential confounder adjustments are reported in the full article tables and supporting materials.