Nearly Half of Elective Surgery Patients Arrived in the Operating Room with Preoperative Anxiety
In eastern Ethiopia, preoperative anxiety emerged as a common and clinically meaningful burden among adults scheduled for elective surgery. Among 414 completed questionnaires from 422 enrolled patients, the proportion with anxiety reached 49.3%, a level high enough to matter at the bedside long before the first incision is made. The finding is more than a psychological footnote. Anxiety before surgery can amplify sympathetic tone, raise blood pressure, accelerate heart rate, and narrow arterial vessels, all of which complicate anesthetic preparation and can make perioperative management less predictable.
The study took place at Jigjiga University Sultan Sheik Hassan Yabare Comprehensive Specialized Hospital in the Somali region of Eastern Ethiopia, where evidence on this problem had been scarce. Adult elective surgical patients were recruited through proportional allocation and consecutive sampling, and anxiety was assessed with the Amsterdam Preoperative Anxiety and Information Scale. The median APAIS score was 11, with an interquartile range of 3, suggesting a meaningful spread in how patients experienced the preoperative period even within the same hospital setting.
A proportion near 50% is not a subtle signal.
Sex, Education, and Fear Were Closely Tied to Anxiety Risk
The analysis identified several factors associated with a higher likelihood of preoperative anxiety. Female patients had substantially greater odds of anxiety than male patients, with an adjusted odds ratio of 3.3. Lower educational attainment also tracked with higher risk: no formal education carried an adjusted odds ratio of 3.0, and primary school education carried an adjusted odds ratio of 3.1. These associations suggest that understanding of the surgical process, access to information, and the ability to process perioperative risks may all shape how patients mentally prepare for surgery.
Fear-related variables were equally important. Fear of death was associated with an adjusted odds ratio of 2.8. Fear of unexpected surgical results was linked to an adjusted odds ratio of 3.3. Fear of physical disability carried an adjusted odds ratio of 2.0, and fear of complications carried an adjusted odds ratio of 2.8. These are not abstract anxieties. They reflect concrete concerns about survival, function, and postoperative life after surgery, and they likely interact with local expectations, prior experiences, and the quality of pre-anesthetic counseling.
In practical terms, these findings point to patients who may benefit most from direct conversation before surgery begins. A patient who is worried about death or postoperative disability is not only expressing distress; the patient is signaling a need for explanation, reassurance, and preparation that matches the emotional weight of the planned operation.
What the APAIS Score Reveals About the Preoperative Visit
The Amsterdam Preoperative Anxiety and Information Scale is designed to capture two linked issues: anxiety itself and the patient’s desire for information. Used in this cohort, it helped quantify what clinicians often see informally in the preoperative area—restlessness, worry, hesitation, and uncertainty about what surgery will mean. The median score of 11 indicates that anxiety was not confined to a small subgroup. It was distributed across the preoperative population in a way that should prompt routine screening rather than selective attention based only on obvious distress.
That matters because the preoperative period is one of the few points in surgical care when anxiety can still be modified. Explanation of the procedure, expected recovery, potential complications, and postoperative function may reduce uncertainty. For some patients, the most useful intervention may be simple, structured communication delivered before the day of surgery rather than a more complex intervention after distress has already escalated.
The study’s cross-sectional design cannot establish causation, yet the associations are biologically and clinically plausible. Anxiety activates the sympathetic nervous system and can destabilize hemodynamics. It can also distort how patients absorb information, making even brief counseling less effective if fear has already narrowed attention. In that setting, low educational status may further limit the ability to translate technical explanations into reassurance.
Pre-Anesthetic Evaluation Needs More Than Vital Signs
Elective surgery often focuses attention on laboratory results, airway assessment, and anesthetic risk. This study argues for a broader pre-anesthetic lens. Psychological readiness is part of surgical readiness, and it can influence both patient experience and physiologic stability. When nearly one in two adults entering elective surgery is anxious, the preoperative visit cannot remain a purely technical encounter.
The findings support routine anxiety assessment during pre-anesthetic evaluation, especially among women, patients with limited formal education, and those expressing fear of death, complications, unexpected outcomes, or disability. Those groups were not marginally different; they carried materially higher adjusted odds of anxiety. Such data can help anesthetic teams identify who may need more time, more explanation, or more targeted counseling before surgery proceeds.
The hospital-based design also gives the findings local relevance. Eastern Ethiopia had limited prior evidence on this issue, so the study fills an important descriptive gap for a region where surgical systems often operate under resource constraints. Even without intervention testing, the data provide a usable clinical map: anxiety is common, it clusters around identifiable concerns, and it should be addressed before the operating room rather than after it.
A Common Symptom with Immediate Bedside Consequences
The most direct consequence of untreated preoperative anxiety is not only emotional distress. It is the physiologic response that can complicate anesthetic induction, increase perioperative instability, and reduce cooperation with preoperative instructions. In a setting where fear is high, patient education is not an optional courtesy; it is part of perioperative risk management.
Routine screening, clear explanations, and counseling tailored to a patient’s educational background may help close that gap. The study leaves open whether structured intervention would lower anxiety scores in this population, but the need for targeted preoperative communication is already evident from the distribution of risk factors. The next step is not more speculation about whether patients are anxious. The next step is building pre-anesthetic workflows that identify distress early enough to respond to it.