Impact of Pre-Operative Consultation on Patient Anxiety and Surgical Outcomes Across Genders in Relation to Literacy Level
Impact of Pre-Operative Consultation on Patient Anxiety and Surgical Outcomes
Keywords:
Preoperative Anxiety and Information Scale; preoperative anxiety; preoperative consultation; educational level; gender; blood pressure; elective surgery.Abstract
Background: Preoperative anxiety is common among surgical patients and may influence physiological responses and perioperative experiences. Preoperative consultation may address patient concerns, although anxiety and information needs may vary according to individual characteristics. Objective: To assess preoperative anxiety and information needs among elective surgical patients receiving preoperative consultation, compare these measures according to gender and educational level, and examine their relationship with selected perioperative outcomes. Methods: This comparative observational study included 52 elective surgical patients recruited from two tertiary-care hospitals in Lahore, Pakistan, from January to April 2025. Preoperative anxiety and information needs were assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Gender and educational-level comparisons and correlations with physiological and postoperative outcomes were analyzed using appropriate non-parametric tests and Pearson's correlation. Results: The mean APAIS anxiety score was 14.29 ± 3.93, with 69.2% of participants classified as having high or very high anxiety. Gender and educational level were not significantly associated with anxiety (p=0.328 and p=0.804, respectively) or information need (p=0.408 and p=0.265, respectively). Consultation was perceived to reduce anxiety by 98.0% of participants. Anxiety correlated significantly with systolic (r=0.400, p=0.003) and diastolic blood pressure (r=0.473, p<0.001), but not with heart rate, postoperative pain, or Aldrete recovery score. Conclusion: Preoperative anxiety was common and was associated with higher blood pressure, while significant gender- or education-related differences were not demonstrated. Individualized preoperative communication may support patient-centered perioperative care. Keywords: Amsterdam Preoperative Anxiety and Information Scale; preoperative anxiety; preoperative consultation; educational level; gender; blood pressure; elective surgery.
References
1. Bedaso A, Mekonnen N, Duko B. Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Open. 2022;12(3):e058187. doi:10.1136/bmjopen-2021-058187.
2. Celik F, Edipoglu IS. Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur J Med Res. 2018;23(1):41. doi:10.1186/s40001-018-0339-4.
3. Ertürk EB, Ünlü H. Effects of pre-operative individualized education on anxiety and pain severity in patients following open-heart surgery. Int J Health Sci (Qassim). 2018;12(4):26-34.
4. Akhlaghi F, Azizi S, Malek B, Mahboubi F, Shams S, Karimizadeh M. Effect of preoperative anesthesia consultation on decreasing anxiety in patients undergoing oral and maxillofacial surgery. J Dent (Shiraz). 2020;21(2):102-105. doi:10.30476/DENTJODS.2019.77883.0.
5. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. J Psychiatr Res. 2011;45(8):1027-1035. doi:10.1016/j.jpsychires.2011.03.006.
6. Demirel A, Balkaya AN, Onur T, Karaca Ü, Onur A. The effect of health literacy on preoperative anxiety levels in patients undergoing elective surgery. Patient Prefer Adherence. 2023;17:1949-1961. doi:10.2147/PPA.S419866.
7. Mavros MN, Athanasiou S, Gkegkes ID, Polyzos KA, Peppas G, Falagas ME. Do psychological variables affect early surgical recovery? PLoS One. 2011;6(5):e20306. doi:10.1371/journal.pone.0020306.
8. Bello CM, Eisler P, Heidegger T. Perioperative anxiety: current status and future perspectives. J Clin Med. 2025;14(5):1422. doi:10.3390/jcm14051422.
9. Aust H, Eberhart L, Sturm T, Schuster M, Nestoriuc Y, Brehm F, et al. A cross-sectional study on preoperative anxiety in adults. J Psychosom Res. 2018;111:133-139. doi:10.1016/j.jpsychores.2018.05.012.
10. Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani surgical patients. J Pak Med Assoc. 2009;59(6):359-363.
11. Acharya S, Gurung R, Parajuli B. Preoperative anxiety assessment in adult patients undergoing elective surgeries: a cross-sectional observational study. J Inst Med Nepal. 2020;42(3):18-22. doi:10.3126/jiom.v42i3.37572.
12. Dibabu AM, Ketema TG, Beyene MM, Belachew DZ, Abocherugn HG, Mohammed AS. Preoperative anxiety and associated factors among women admitted for elective obstetric and gynecologic surgery in public hospitals, Southern Ethiopia: a cross-sectional study. BMC Psychiatry. 2023;23:728. doi:10.1186/s12888-023-05005-2.
13. Nigussie S, Belachew T, Wolancho W. Predictors of preoperative anxiety among surgical patients in Jimma University Specialized Teaching Hospital, South Western Ethiopia. BMC Surg. 2014;14:67. doi:10.1186/1471-2482-14-67.
14. Dias P, Clerc D, Rodrigues MGR, Demartines N, Grass F, Hübner M. Impact of an operating room nurse preoperative dialogue on anxiety, satisfaction and early postoperative outcomes in patients undergoing major visceral surgery—a single center, open-label, randomized controlled trial. J Clin Med. 2022;11(7):1895. doi:10.3390/jcm11071895.
15. Lemos MF, Lemos-Neto SV, Barrucand L, Verçosa N, Tibirica E. Preoperative education reduces preoperative anxiety in cancer patients undergoing surgery: usefulness of the self-reported Beck anxiety inventory. Braz J Anesthesiol. 2019;69(1):1-6. doi:10.1016/j.bjane.2018.07.004.
16. Ji W, Sang C, Zhang X, Zhu K, Bo L. Personality, preoperative anxiety, and postoperative outcomes: a review. Int J Environ Res Public Health. 2022;19(19):12162. doi:10.3390/ijerph191912162
