Pre-operative anxiety amongst patients in a tertiary care hospital in India- a prevalence study
DOI:
https://doi.org/10.3126/jsan.v4i1.17377Keywords:
anaesthesia, anxiety, anxiety scale, preoperative period, prevalenceAbstract
Background: The prospect of undergoing surgery under anaesthesia can induce significant anxiety in patients. Excess anxiety can lead to several deleterious effects like perioperative cardiac events, increased anaesthetic requirements, higher postoperative pain scores and prolonged hospital stay. Various factors can influence the anxiety levels during surgery. The aim of the study was to estimate the prevalence of anxiety in adult patients scheduled for surgery in a suburban teaching institute in India where the majority of patients belong to lower socioeconomic strata.
Methods: One hundred consecutive patients scheduled for various elective surgeries were asked 6 questions according to the Amsterdam preoperative anxiety and information scale to assess their anxiety levels just before shifting into the Operating room. Probable contributing factors noted were age, sex, socioeconomic status, type of surgery, duration of hospital stay, and history of previous surgery. Any specific factors causing anxiety like failure or complications of surgery, recovery from anaesthesia, needle pricks were also asked with leading questions.
Results: The overall prevalence of anxiety was 31%. The prevalence in male patients and female patients were 21.2% and 39.5% respectively. There was a moderate correlation between the anxiety scores and need to know scores. The effects of sex, previous surgery, the length of hospital stay were not significant upon the anxiety scores.
Conclusion: The overall prevalence of anxiety in the southern part of India was lower when compared to many of the reported studies; however, the prevalence was higher among the female patients.
References
<ol>
<li>Mitchell M. Anaesthesia type, gender and anxiety. J Perioper Pract 2013;23(3):41-7. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23586187">[PMid:23586187]</a></li>
<li>Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg 1999;89(6):1346-51. <a href="https://www.ncbi.nlm.nih.gov/pubmed/10589606">[PMid:10589606]</a></li>
<li>Ip HYV, Abrishami A, Peng PWH, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2009;111(3):657-77. <a href="https://doi.org/10.1097/ALN.0b013e3181aae87a">https://doi.org/10.1097/ALN.0b013e3181aae87a</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/19672167">[PMid:19672167]</a></li>
<li>Pearson S, Maddern GJ, Fitridge R. The role of pre-operative state-anxiety in the determination of intra-operative neuroendocrine responses and recovery. Br J Health Psychol 2005;10:299-310. <a href="https://doi.org/10.1348/135910705X26957">https://doi.org/10.1348/135910705X26957</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/15969856">[PMid:15969856]</a></li>
<li>Szekely A, Balog P, Benko E, Breuer T, Szekely J, Kertai MD, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery- a 4-year follow-up study. Psychosom Med 2007;69(7):625-31. <a href="https://doi.org/10.1097/PSY.0b013e31814b8c0f">https://doi.org/10.1097/PSY.0b013e31814b8c0f</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/17724254">[PMid:17724254]</a></li>
<li>Mitchell M. General anaesthesia and day-case patient anxiety. J Adv Nurs 2010;66(5):1059-71. <a href="https://doi.org/10.1111/j.1365-2648.2010.05266.x">https://doi.org/10.1111/j.1365-2648.2010.05266.x</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/20337788">[PMid:20337788]</a></li>
<li>Fox C, Liu H, Kaye AD, Manchikanti L, Trescot AM, Christo PJ. Clinical aspects of pain medicine and interventional pain management: a comprehensive review. Paducah, KY: ASIP Publishing. Antianxiety agents. 2011:543-52.</li>
<li>Griffin CE, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system mediated effects. Ochsner J 2013;13(2):214-23. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23789008">[PMid:23789008]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/">[PMCid:PMC3684331]</a></li>
<li>Beydon L, Rouxel A, Camut N, Schinkel N, Malinovsky J-M, Aveline C, et al. Sedative premedication before surgery-A multicentre randomized study versus placebo. Anaesth Crit Care Pain Med 2015;34(3):165-71. <a href="https://doi.org/10.1016/j.accpm.2015.01.005">https://doi.org/10.1016/j.accpm.2015.01.005</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26004882">[PMid:26004882]</a></li>
<li>Soltner C, Giquello JA, Monrigal-Martin C, Beydon L. Continuous care and empathic anaesthesiologist attitude in the preoperative period: impact on patient anxiety and satisfaction. Br J Anaesth 2011;106(5):680-6. <a href="https://doi.org/10.1093/bja/aer034">https://doi.org/10.1093/bja/aer034</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/21414978">[PMid:21414978]</a></li>
<li>Jlala HA, French JL, Foxall GL, Hardman JG, Bedforth NM. Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. Br J Anaesth 2010;104(3):369-74. <a href="https://doi.org/10.1093/bja/aeq002">https://doi.org/10.1093/bja/aeq002</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/20124283">[PMid:20124283]</a></li>
<li>Nikumb VB, Banerjee A, Kaur G, Chaudhury S. Impact of doctor-patient communication on preoperative anxiety: Study at industrial township, Pimpri, Pune. Ind Psychiatry J 2009;18(1):19-21. <a href="https://doi.org/10.4103/0972-6748.57852">https://doi.org/10.4103/0972-6748.57852</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/21234156">[PMid:21234156]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016692/">[PMCid:PMC3016692]</a></li>
<li>Akkamahadevi P, Subramanian VV. The efficacy of different methods of pre-operative counselling on perioperative anxiety in patients undergoing regional anaesthesia. Indian J Anaesth 2016;60(1):58. <a href="https://doi.org/10.4103/0019-5049.174812">https://doi.org/10.4103/0019-5049.174812</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26962258">[PMid:26962258]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782426/">[PMCid:PMC4782426]</a></li>
<li>Berth H, Petrowski K, Balck F. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) - the first trial of a German version. Psycho-Soc Med 2007;4:Doc01. <a href="https://www.ncbi.nlm.nih.gov/pubmed/19742298">[PMid:19742298]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736533/">[PMCid:PMC2736533]</a></li>
<li>del Carmen Gavito M, Corona MA, Villagran ME, Morales J, Tellez JL, Ortega-Soto HA. La informacion anestesica quirurgica: su efecto sobre la ansiedad y el dolor de los pacientes toracotomizados. Rev Inst Nal Enf Resp Mex 2000;13(3):153-6.</li>
<li>Kunthonluxamee A, Pitimana-aree S, Laurujisawat P. Validity and Reliability of the Amsterdam Preoperative Anxiety and Information Scale (APAIS); Thai version in adult Thai pre-operative patients. J Psychiatr Assoc Thailand 2013;54(1):83-92.</li>
<li>Shin WJ, Kim YC, Yeom JH, Cho SY, Lee DH, Kim DW. The Validity of Amsterdam Preoperative Anxiety Information Scale in the Assessment of the Preoperative Anxiety - Compared with hospital anxiety depression scale and visual analogue scale. Korean J Anesthesiol 1999;37(2):179-87. <a href="https://doi.org/10.4097/kjae.1999.37.2.179">https://doi.org/10.4097/kjae.1999.37.2.179</a></li>
<li>Nishimori M, Moerman N, Fukuhara S, van Dam FS, Muller MJ, Hanaoka K, et al. Translation and validation of the Amsterdam preoperative anxiety and information scale (APAIS) for use in Japan. Qual Life Res 2002;11(4):361-4. <a href="https://doi.org/10.1023/A:1015561129899">https://doi.org/10.1023/A:1015561129899</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/12086121">[PMid:12086121]</a></li>
<li>Matthias AT, Samarasekera DN. Preoperative anxiety in surgical patients-experience of a single unit. Acta Anaesthesiol Taiwanica 2012;50(1):3-6. <a href="https://doi.org/10.1016/j.aat.2012.02.004">https://doi.org/10.1016/j.aat.2012.02.004</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/22500906">[PMid:22500906]</a></li>
<li>Dudala SR. Updated Kuppuswamy's socioeconomic scale for 2012. J NTR Univ Health Sci 2013;2:201-2. <a href="https://doi.org/10.4103/2277-8632.117195">https://doi.org/10.4103/2277-8632.117195</a></li>
<li>Haugen AS, Eide GE, Olsen MV, Haukeland B, Remme AR, Wahl AK. Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus or regional anaesthesia. J Clin Nurs 2009;18(16):2301-10. <a href="https://doi.org/10.1111/j.1365-2702.2009.02792.x">https://doi.org/10.1111/j.1365-2702.2009.02792.x</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/19583663">[PMid:19583663]</a></li>
<li>Pokharel K, Bhattarai B, Tripathi M, Khatiwada S, Subedi A. Nepalese patients anxiety and concerns before surgery. J Clin Anesth 2011;23(5):372-8. <a href="https://doi.org/10.1016/j.jclinane.2010.12.011">https://doi.org/10.1016/j.jclinane.2010.12.011</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/21802628">[PMid:21802628]</a></li>
<li>Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg 1996;82(3):445-51. <a href="https://www.ncbi.nlm.nih.gov/pubmed/8623940">[PMid:8623940]</a></li>
<li>Akinsulore A, Owojuyigbe AM, Faponle AF, Fatoye FO. Assessment of preoperative and postoperative anxiety among elective major surgery patients in a tertiary hospital in Nigeria. Middle East J Anaesthesiol 2015;23(2):235-40. <a href="https://www.ncbi.nlm.nih.gov/pubmed/26442401">[PMid:26442401]</a></li>
<li>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. <a href="https://doi.org/10.1186/1471-2482-14-67">https://doi.org/10.1186/1471-2482-14-67</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/25189274">[PMid:25189274]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167307/">[PMCid:PMC4167307]</a></li>
<li>Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani surgical patients. J Pak Med Assoc 2009;59(6):359-63. <a href="https://www.ncbi.nlm.nih.gov/pubmed/19534368">[PMid:19534368]</a></li>
<li>Ebirim LN, Tobin M. Factors Responsible For Pre-Operative Anxiety In Elective Surgical Patients At A University Teaching Hospital: A Pilot Study. Internet J Anesthesiol [Internet]. 2010 Dec 31 [cited 2017 Jan 15];29(2). Available from: <a href="http://ispub.com/IJA/29/2/8534">http://ispub.com/IJA/29/2/8534</a></li>
</ol>
<li>Mitchell M. Anaesthesia type, gender and anxiety. J Perioper Pract 2013;23(3):41-7. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23586187">[PMid:23586187]</a></li>
<li>Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg 1999;89(6):1346-51. <a href="https://www.ncbi.nlm.nih.gov/pubmed/10589606">[PMid:10589606]</a></li>
<li>Ip HYV, Abrishami A, Peng PWH, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2009;111(3):657-77. <a href="https://doi.org/10.1097/ALN.0b013e3181aae87a">https://doi.org/10.1097/ALN.0b013e3181aae87a</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/19672167">[PMid:19672167]</a></li>
<li>Pearson S, Maddern GJ, Fitridge R. The role of pre-operative state-anxiety in the determination of intra-operative neuroendocrine responses and recovery. Br J Health Psychol 2005;10:299-310. <a href="https://doi.org/10.1348/135910705X26957">https://doi.org/10.1348/135910705X26957</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/15969856">[PMid:15969856]</a></li>
<li>Szekely A, Balog P, Benko E, Breuer T, Szekely J, Kertai MD, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery- a 4-year follow-up study. Psychosom Med 2007;69(7):625-31. <a href="https://doi.org/10.1097/PSY.0b013e31814b8c0f">https://doi.org/10.1097/PSY.0b013e31814b8c0f</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/17724254">[PMid:17724254]</a></li>
<li>Mitchell M. General anaesthesia and day-case patient anxiety. J Adv Nurs 2010;66(5):1059-71. <a href="https://doi.org/10.1111/j.1365-2648.2010.05266.x">https://doi.org/10.1111/j.1365-2648.2010.05266.x</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/20337788">[PMid:20337788]</a></li>
<li>Fox C, Liu H, Kaye AD, Manchikanti L, Trescot AM, Christo PJ. Clinical aspects of pain medicine and interventional pain management: a comprehensive review. Paducah, KY: ASIP Publishing. Antianxiety agents. 2011:543-52.</li>
<li>Griffin CE, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system mediated effects. Ochsner J 2013;13(2):214-23. <a href="https://www.ncbi.nlm.nih.gov/pubmed/23789008">[PMid:23789008]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/">[PMCid:PMC3684331]</a></li>
<li>Beydon L, Rouxel A, Camut N, Schinkel N, Malinovsky J-M, Aveline C, et al. Sedative premedication before surgery-A multicentre randomized study versus placebo. Anaesth Crit Care Pain Med 2015;34(3):165-71. <a href="https://doi.org/10.1016/j.accpm.2015.01.005">https://doi.org/10.1016/j.accpm.2015.01.005</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26004882">[PMid:26004882]</a></li>
<li>Soltner C, Giquello JA, Monrigal-Martin C, Beydon L. Continuous care and empathic anaesthesiologist attitude in the preoperative period: impact on patient anxiety and satisfaction. Br J Anaesth 2011;106(5):680-6. <a href="https://doi.org/10.1093/bja/aer034">https://doi.org/10.1093/bja/aer034</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/21414978">[PMid:21414978]</a></li>
<li>Jlala HA, French JL, Foxall GL, Hardman JG, Bedforth NM. Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. Br J Anaesth 2010;104(3):369-74. <a href="https://doi.org/10.1093/bja/aeq002">https://doi.org/10.1093/bja/aeq002</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/20124283">[PMid:20124283]</a></li>
<li>Nikumb VB, Banerjee A, Kaur G, Chaudhury S. Impact of doctor-patient communication on preoperative anxiety: Study at industrial township, Pimpri, Pune. Ind Psychiatry J 2009;18(1):19-21. <a href="https://doi.org/10.4103/0972-6748.57852">https://doi.org/10.4103/0972-6748.57852</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/21234156">[PMid:21234156]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016692/">[PMCid:PMC3016692]</a></li>
<li>Akkamahadevi P, Subramanian VV. The efficacy of different methods of pre-operative counselling on perioperative anxiety in patients undergoing regional anaesthesia. Indian J Anaesth 2016;60(1):58. <a href="https://doi.org/10.4103/0019-5049.174812">https://doi.org/10.4103/0019-5049.174812</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/26962258">[PMid:26962258]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782426/">[PMCid:PMC4782426]</a></li>
<li>Berth H, Petrowski K, Balck F. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) - the first trial of a German version. Psycho-Soc Med 2007;4:Doc01. <a href="https://www.ncbi.nlm.nih.gov/pubmed/19742298">[PMid:19742298]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2736533/">[PMCid:PMC2736533]</a></li>
<li>del Carmen Gavito M, Corona MA, Villagran ME, Morales J, Tellez JL, Ortega-Soto HA. La informacion anestesica quirurgica: su efecto sobre la ansiedad y el dolor de los pacientes toracotomizados. Rev Inst Nal Enf Resp Mex 2000;13(3):153-6.</li>
<li>Kunthonluxamee A, Pitimana-aree S, Laurujisawat P. Validity and Reliability of the Amsterdam Preoperative Anxiety and Information Scale (APAIS); Thai version in adult Thai pre-operative patients. J Psychiatr Assoc Thailand 2013;54(1):83-92.</li>
<li>Shin WJ, Kim YC, Yeom JH, Cho SY, Lee DH, Kim DW. The Validity of Amsterdam Preoperative Anxiety Information Scale in the Assessment of the Preoperative Anxiety - Compared with hospital anxiety depression scale and visual analogue scale. Korean J Anesthesiol 1999;37(2):179-87. <a href="https://doi.org/10.4097/kjae.1999.37.2.179">https://doi.org/10.4097/kjae.1999.37.2.179</a></li>
<li>Nishimori M, Moerman N, Fukuhara S, van Dam FS, Muller MJ, Hanaoka K, et al. Translation and validation of the Amsterdam preoperative anxiety and information scale (APAIS) for use in Japan. Qual Life Res 2002;11(4):361-4. <a href="https://doi.org/10.1023/A:1015561129899">https://doi.org/10.1023/A:1015561129899</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/12086121">[PMid:12086121]</a></li>
<li>Matthias AT, Samarasekera DN. Preoperative anxiety in surgical patients-experience of a single unit. Acta Anaesthesiol Taiwanica 2012;50(1):3-6. <a href="https://doi.org/10.1016/j.aat.2012.02.004">https://doi.org/10.1016/j.aat.2012.02.004</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/22500906">[PMid:22500906]</a></li>
<li>Dudala SR. Updated Kuppuswamy's socioeconomic scale for 2012. J NTR Univ Health Sci 2013;2:201-2. <a href="https://doi.org/10.4103/2277-8632.117195">https://doi.org/10.4103/2277-8632.117195</a></li>
<li>Haugen AS, Eide GE, Olsen MV, Haukeland B, Remme AR, Wahl AK. Anxiety in the operating theatre: a study of frequency and environmental impact in patients having local, plexus or regional anaesthesia. J Clin Nurs 2009;18(16):2301-10. <a href="https://doi.org/10.1111/j.1365-2702.2009.02792.x">https://doi.org/10.1111/j.1365-2702.2009.02792.x</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/19583663">[PMid:19583663]</a></li>
<li>Pokharel K, Bhattarai B, Tripathi M, Khatiwada S, Subedi A. Nepalese patients anxiety and concerns before surgery. J Clin Anesth 2011;23(5):372-8. <a href="https://doi.org/10.1016/j.jclinane.2010.12.011">https://doi.org/10.1016/j.jclinane.2010.12.011</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/21802628">[PMid:21802628]</a></li>
<li>Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg 1996;82(3):445-51. <a href="https://www.ncbi.nlm.nih.gov/pubmed/8623940">[PMid:8623940]</a></li>
<li>Akinsulore A, Owojuyigbe AM, Faponle AF, Fatoye FO. Assessment of preoperative and postoperative anxiety among elective major surgery patients in a tertiary hospital in Nigeria. Middle East J Anaesthesiol 2015;23(2):235-40. <a href="https://www.ncbi.nlm.nih.gov/pubmed/26442401">[PMid:26442401]</a></li>
<li>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. <a href="https://doi.org/10.1186/1471-2482-14-67">https://doi.org/10.1186/1471-2482-14-67</a> <a href="https://www.ncbi.nlm.nih.gov/pubmed/25189274">[PMid:25189274]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167307/">[PMCid:PMC4167307]</a></li>
<li>Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani surgical patients. J Pak Med Assoc 2009;59(6):359-63. <a href="https://www.ncbi.nlm.nih.gov/pubmed/19534368">[PMid:19534368]</a></li>
<li>Ebirim LN, Tobin M. Factors Responsible For Pre-Operative Anxiety In Elective Surgical Patients At A University Teaching Hospital: A Pilot Study. Internet J Anesthesiol [Internet]. 2010 Dec 31 [cited 2017 Jan 15];29(2). Available from: <a href="http://ispub.com/IJA/29/2/8534">http://ispub.com/IJA/29/2/8534</a></li>
</ol>
Downloads
Published
2017-06-28
How to Cite
Vadhanan, P., Tripaty, D. K., & Balakrishnan, K. (2017). Pre-operative anxiety amongst patients in a tertiary care hospital in India- a prevalence study. Journal of Society of Anesthesiologists of Nepal, 4(1), 5-10. https://doi.org/10.3126/jsan.v4i1.17377
Issue
Section
Original Article
License
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC-BY-NC-4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
