Prevalence of Preoperative Anxiety and its Contributing Risk Factors in Adult Patients Undergoing Elective Surgery

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يعاقبة, أيمن محمد
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An-Najah National University
Background: Hospitalization and waiting for a surgical operation are the main arising causes for patient anxiety preoperatively, which significantly affects the outcome of both anaesthesia and surgery. Yet, no researches have been conducted and there is currently no published data on the preoperative anxiety levels in the West Bank (Palestinian Territories). The purpose of this study is to assess the level of preoperative anxiety among patients waiting for elective surgery in Rafidia Governmental Hospital. Methods: A cross sectional study was carried out on 320 patients scheduled for elective surgery at the preoperative care unit (recovery room) in Rafidia Governmental Hospital, Nablus, West Bank (Palestinian Territories). The patients’ medical records were reviewed to obtain demographic data, the surgical and medical diagnosis, medication, and medical history of the study participants. All inpatients were assigned an ASA (American Society of Anaesthesiologists) physical status of I or II, were between 18 and 60 years old, and were able to give informed consent and answer questions were enrolled in this study. Illiterate patients, patients with psychological impairment, pregnant women, and alcoholic patients were excluded from the study. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) was applied to assess the level of patient anxiety. SPSS was applied for statistical analysis and description. Results: The mean age ± SD of the sample was 37.20 ± 10.99 years. The majority of interviewed patients were females (197; 61.6%), married (239, 74.7%), and had no previous surgical operations (225, 70.3%). Less than one third of studied patients had a college education (101, 31.6%) and the majority were scheduled for general anaesthesia (267, 83.4%), while the remaining were scheduled for regional anaesthesia. Approximately one third of the sample ware smokers (108, 33.8%), and less than one half were scheduled for a major operation (137, 42.8%). The majority of patients were ASA category I (267, 83.4%). Using a cut-off point of 11, patients with an anxiety score ≥ 11 on the APAIS were considered anxious. Analysis showed that 184 (57.5%) patients were anxious. The results also indicated that 163 (50.9%) patients indicated a desire for more information about anaesthesia and surgery. Females were more anxious than males (p<0.001). Analysis also showed that non-smokers had significantly higher anxiety scores than smokers (p<0.001). There was no significant difference in anxiety scores between those who had college education and those with lesser levels of education (p=0.83). Patients with no previous surgery did not have significantly higher anxiety scores than those with surgical history (p=0.052). Patients with type II ASA had significantly higher anxiety scores than those with ASA type I (p=0.001). Patients scheduled for GA had significantly higher anxiety scores than those scheduled for regional anaesthesia (p=0.001). No significant difference was found between currently married and unmarried patients in anxiety scores (p=0.58). Patients over 40 years of age had no significant difference in anxiety scores compared with those less than 40 years of age (p=0.55). The results also showed that anxious patients had a higher desire for seeking information about anaesthesia and surgery than non-anxious patients. Conclusion: The prevalence of preoperative anxiety in the West Bank is high compared with results from developed countries, but it correlates with the results from developing countries. Female patients, non-smokers, patients with no previous history of surgery, ASA II patients, and patients undergoing surgery under general anaesthesia had significant anxiety levels. Our study showed that patients with high information requirements, females, and patients scheduled for general anaesthesia are more anxious preoperatively. Assessment of preoperative anxiety is an important step in developing new strategies for reducing anxiety. Assessment can be easily done with a questionnaire such as APAIS, which is a short and economical instrument, and its validity and reliability has been approved. Recommendations: This study advises that providing more information regarding surgery and anaesthesia might help in reducing preoperative anxiety levels. Also, it is a must to increase trust between patients and the medical team (doctors and nurses) by improving doctors’ and nurses capacity in building (doctor, nurse)-patient trust through training courses. This study was conducted in one governmental hospital and it is the first study conducted in the assessment of preoperative anxiety level, so further research should be conducted in other governmental and specialized hospitals in Palestine in this field to recognize and identify level and causes of preoperative anxiety in order to introduce effective methods and strategies to help reduce preoperative anxiety. This study revealed a high level of preoperative anxiety among surgical patients, which emphasizes on that ,new protocols and systems must be established and followed in our government hospitals to decrease the high level of preoperative anxiety levels, which leads decrease the intra and postoperative complications.