Frequency Of Anxiety in Pre-Operative Surgical Patients in the Tertiary Care Hospitals, Karachi

Main Article Content

Salma Parveen
Naveed Ali Khan
Hira Fatima Waseem
Maryam Moula Bakhsh
Atif Aziz


Background: Preoperative anxiety significantly impacts patient outcomes and healthcare delivery, with varying degrees of prevalence reported globally. Understanding and managing this anxiety are crucial for improving surgical experiences and patient recovery. This study focuses on tertiary care hospitals in Karachi, aiming to elucidate the frequency and determinants of preoperative anxiety among elective surgery patients.

Objective: To ascertain the prevalence of preoperative anxiety among patients awaiting elective surgeries in various surgical units of tertiary care hospitals in Karachi and to identify significant contributing factors.

Methods: In a prospective cross-sectional design, 400 patients scheduled for elective surgeries across six surgical units were assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). SPSS version 24 facilitated the analysis, focusing on global anxiety prevalence and its associations with demographic and clinical variables.

Results: The study revealed a 62.0% prevalence of preoperative global anxiety. The APAIS scores indicated higher anxiety related to the surgery (mean = 7.27 ± 2.31) compared to anesthesia (mean = 5.14 ± 2.35). Significant associations were found between anxiety levels and age groups (p=0.002), surgical procedures (p<0.001), and type of anesthesia (p<0.001). ENT and urology patients exhibited notably higher anxiety, at 75.0% and 68.0% respectively. Multivariate analysis demonstrated a significant impact of gender on preoperative anxiety, with females showing increased vulnerability [aOR 1.91 (95% CI 1.13-3.21); p=0.015].

Conclusion: Preoperative anxiety remains a prevalent concern, with female patients exhibiting higher levels of anxiety than their male counterparts. The findings advocate for targeted counseling and informational support for patients, especially females, prior to surgery and anesthesia consultations, underscoring the need for healthcare professionals to address and mitigate preoperative anxiety effectively.

Article Details

How to Cite
Parveen, S., Khan, N. A., Waseem, H. F., Bakhsh, M. M., & Aziz, A. (2024). Frequency Of Anxiety in Pre-Operative Surgical Patients in the Tertiary Care Hospitals, Karachi. Journal of Health and Rehabilitation Research, 4(1), 1587–1596.
Author Biographies

Salma Parveen, Dow University of Health Sciences Karachi Pakistan

Lecturer, Dow Institute of Medical Technology, Dow University of Health Sciences Karachi Pakistan

Naveed Ali Khan, Dow University of Health Sciences Karachi Pakistan

Professor of Surgery and Vice Principal, Dow International Medical College, Dow University of Health Sciences Karachi Pakistan

Hira Fatima Waseem, Dow University of Health Sciences Karachi Pakistan

Lecturer, School of Public Health, Dow University of Health Sciences Karachi Pakistan

Maryam Moula Bakhsh, Dow University of Health Sciences Karachi Pakistan

Assistant Professor, Dow Institute of Medical Technology, Dow University of Health Sciences Karachi Pakistan

Atif Aziz, Iqra University Karachi Pakistan.

Professor, Iqra University Karachi Pakistan


Gruen RL, Jurkovich GJ, McIntyre LK, Foy HM, Maier RV. Patterns of errors contributing to trauma mortality: lessons learned from 2594 deaths. Annals of surgery. 2006;244(3):371.

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.

Afrassa N, Kassa RN, Legesse TG. Preoperative anxiety and its associated factors among patients undergoing cardiac catheterization at saint peter Specialized Hospital and Addis Cardiac Center, Addis Ababa, Ethiopia. International Journal of Africa Nursing Sciences. 2022;17:100430.

Antonis T. PERIOPERATIVE PSYCHIATRIC DISORDERS. International Journal of Drug Discovery and Medical Research. 2023;12(1):5-12.

Caceres TA. Elucidating the Effects of Clarity Direct Neurofeedback on the Post-Traumatic Stress Disorder Symptoms of a Young Adult: A Case Study: Alliant International University; 2023.

OYEDIRAN OO, FWACN ATO, AYANDIRAN EO. Preoperative Anxiety, Expectations and Challenges of Surgical Patients in a South Western State’s Hospitals, Nigeria. International Journal of Nursing. 2022;9(1):32-41.

Barkhori A, Pakmanesh H, Sadeghifar A, Hojati A, Hashemian M. Preoperative anxiety among Iranian adult patients undergoing elective surgeries in educational hospitals. Journal of Education and Health Promotion. 2021;10.

Ji W, Sang C, Zhang X, Zhu K, Bo L. Personality, Preoperative Anxiety, and Postoperative Outcomes: A Review. International Journal of Environmental Research and Public Health. 2022;19(19):12162.

Shewangzaw Engda A, Belay Yigzaw H, Alemnew Engdaw N, Admasu Basha E, Adem A, Dargie Wubetu A, et al. Magnitude of Preoperative Anxiety and Associated Factors Among Adult Surgical Patients in Debre Berhan Comprehensive Specialized Hospital. International Journal of General Medicine. 2022:5999-6007.

Spanner S, Sayer L. Is the Amsterdam Preoperative Anxiety and Information Scale (APAIS) a Valid Tool in Guiding the Management of Preoperative Anxiety in Adult Patients. A Literature Review. Journal of Nursing and Practice. 2019;3(1):95-102.

Jayawardane M, Gankanda W, Gunathilake M. Prevalence of pre-operative anxiety and associated factors among a group of women undergoing gynaecological surgeries at a single unit in a tertiary care hospital in Sri Lanka. F1000Research. 2021;10.

Abate SM, Chekol YA, Basu B. Global prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and meta-analysis. International Journal of Surgery Open. 2020;25:6-16.

Markiewicz-Gospodarek A, Kozioł M, Tobiasz M, Baj J, Radzikowska-Büchner E, Przekora A. Burn wound healing: clinical complications, medical care, treatment, and dressing types: the current state of knowledge for clinical practice. International Journal of Environmental Research and Public Health. 2022;19(3):1338.

Woldegerima Y, Fitwi G, Yimer H, Hailekiros A. Prevalence and factors associated with preoperative anxiety among elective surgical patients at University of Gondar Hospital. Gondar, Northwest Ethiopia, 2017. A cross-sectional study. International Journal of Surgery Open. 2018;10:21-9.

Eberhart L, Aust H, Schuster M, Sturm T, Gehling M, Euteneuer F, et al. Preoperative anxiety in adults-a cross-sectional study on specific fears and risk factors. BMC psychiatry. 2020;20(1):1-14.

Valencia L, Becerra Á, Ojeda N, Domínguez A, Prados M, González-Martín JM, et al. Effect of preoperative anxiety on postoperative pain after craniotomy. Journal of Clinical Medicine. 2022;11(3):556.

Ayele B, Tadesse M, Tilahun R, Nega B. Translation of the Amsterdam Preoperative Anxiety and Information Score (APAIS) into the amharic version and its validation for evaluation of preoperative anxiety. Ethiopian Journal of Health Sciences. 2021;31(2).

Turrado V, Guzmán Y, Jiménez-Lillo J, Villegas E, de Lacy FB, Blanch J, et al. Exposure to virtual reality as a tool to reduce peri-operative anxiety in patients undergoing colorectal cancer surgery: a single-center prospective randomized clinical trial. Surgical Endoscopy. 2021;35:4042-7.

Gürler H, Yılmaz M, Türk KE. Preoperative anxiety levels in surgical patients: A comparison of three different scale scores. Journal of PeriAnesthesia Nursing. 2022;37(1):69-74.

Mou Q, Gao M, Liu X, Wei C, Lan G, Zhao X, et al. Preoperative anxiety as an independent predictor of postoperative delirium in older patients undergoing elective surgery for lumbar disc herniation. Aging Clinical and Experimental Research. 2023;35(1):85-90.

Maiye SE, Dal Yılmaz Ü. Assessment of Preoperative Anxiety Among Surgical Patients. Midwifery.2(2):53-61.

YEDİYILDIZ MB, YILMAZ R, BÜYÜKBEZİRCİ G, ARICAN Ş, TAVLAN A. Evaluation of the Relationship Between Preoperative Patient Anxiety Level and Health Literacy. Journal of Contemporary Medicine. 2023;13(3):540-4.

Aust H, Eberhart L, Sturm T, Schuster M, Nestoriuc Y, Brehm F, et al. A cross-sectional study on preoperative anxiety in adults. Journal of Psychosomatic Research. 2018;111:133-9.

Guo P, Li P, Zhang X, Liu N, Wang J, Yang S, et al. The effectiveness of aromatherapy on preoperative anxiety in adults: A systematic review and meta-analysis of randomized controlled trials. International Journal of Nursing Studies. 2020;111:103747.

Habimana S, Biracyaza E, Mpunga T, Nsabimana E, Kayitesi F, Nzamwita P, et al. Prevalence and associated factors of depression and anxiety among patients with cancer seeking treatment at the Butaro Cancer Center of Excellence in Rwanda. Frontiers in Public Health. 2023;11:972360.