Nepalese patients' anxiety and concerns before surgery

Abstract

Study objective: To determine the changes in anxiety level and need for information at three different time points before surgery.

Design: Prospective observational study.

Setting: Ward (T(1)), preoperative holding area (T(2)), and operating room (T(3)) of a university hospital.

Patients: 201 adult, ASA physical status 1 and 2 patients scheduled for elective operations.

Measurements: Level of anxiety and need for information about surgery and/or anesthesia were assessed with the Amsterdam Preoperative Anxiety and Information Scale (APAIS) three times before the start of surgery: in the ward, the preoperative holding area, and the operating room.

Results: The psychometric characteristics of the APAIS were similar to its original Dutch version. The frequency of patients with high preoperative anxiety peaked at the preoperative holding area. The median score on need for information decreased from T(1) [4; interquartile range (IR) 2-5] to T(2) (3; IR 2-4) (P < 0.005) and T(3) (3; IR 2-4) (P < 0.01). While the mean anxiety scores for anesthesia were significantly (P < 0.001) higher than for the surgical procedure at all three time points, when patients were still in the ward their need for information about their surgical procedure was significantly (P < 0.05) greater than it was for the anesthesia. Patients who were more desirous of information also were more anxious (P < 0.001). Predictors of high anxiety were female gender [odds ratio (OR) 4; 95% confidence interval (CI) 1.09-14.94] and need for general anesthesia (OR 7.1; 95% CI 0.93-54.98). The characteristics, general anesthesia (OR 3.3; 95% CI 1.1-10.0), younger age (≤ 30 yrs; OR 2.9; 95% CI 1.3-6.4), education (>12 yrs; OR 2.6; 95% CI 1.2-5.4), and no previous surgery (OR 2.6; 95% CI 1.2-5.5), correlated with greater need for information.

Conclusion: The frequency of anxious patients is variable at different time points before surgery. The factors correlating with anxiety before surgery are nonmodifiable. Providing information to those individuals is the only modifiable option.