The prevalence of postoperative pain and its association with preoperative anxiety: A cross-sectional study at a tertiary hospital in Johannesburg, South Africa

Odontectomy is a surgical procedure to extract impacted teeth and also commonly performed to address dental and oral health issues. One symptom observed prior to the procedure is anxiety that may cause patients to avoid dental care. One effect attributed to preoperative anxiety in odontectomy patients includes a decrease in pain control, encompassing postoperative pain, possibly through Hypothalamic-Pituitary-Adrenal (HPA) axis. Postoperative pain itself is a complex issue requiring effective management to ensure good healing. This study aimed to determine the relationship between preoperative anxiety and postoperative pain in odontectomy patients under general anesthesia at Moewardi General Hospital and to measure the relationship between preoperative anxiety and postoperative pain intensity in patients undergoing odontectomy under general anesthesia at Moewardi General Hospital. This was a cross-sectional study of which the data were obtained through interviews. A total of 30 samples were selected from the Dental and Oral Outpatient Clinic at Moewardi General Hospital scheduled for odontectomy under general anesthesia from December 2022 to January 2023. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) questionnaire and Visual Analogue Score for Pain were used respectively to measure preoperative anxiety and postoperative pain. Statistical analysis of the relationship was conducted using the Pearson Correlation Test to assess the strength of the relationship. The average preoperative anxiety level was 17.17 and the postoperative pain intensity was 3.93 with the correlation coefficient of 0.587 (p < 0.05), indicating that the relationship fell within moderate and significant category. Preoperative anxiety exhibited a moderate and significant correlation with postoperative pain in odontectomy patients under general anesthesia.

Preoperative anxiety is not systematically assessed during premedication appointments, although it may influence the postoperative course and outcome. The aim of this study was to assess preoperative anxiety in a sample of patients before major urological surgery and to characterize the impact on postoperative pain. An additional aim was to analyze the agreement between patients' self-ratings and physicians' anxiety ratings. In all, 127 male and 27 female patients participated in a prospective observational study. Preoperative anxiety was assessed with two validated instruments - the APAIS (Amsterdam Preoperative Anxiety and Information Scale) and the State Scale of the STOA questionnaire (State-Trait Operation Anxiety) - during the premedication appointment. Physicians provided their subjective ratings on patients' anxiety and need for information using the APAIS. The predictive value of preoperative anxiety for postoperative pain was evaluated. Nearly four out of ten patients were identified as "anxiety cases"; thereof women were more afraid than men were. Preoperative anxiety was not correctly assessed by physicians, who overestimated patients' anxiety. In female patients, preoperative anxiety was predictive of increased postoperative pain scores. Preoperative anxiety is a frequent concern and often not correctly assessed by physicians. The use of scoring systems to detect preoperative anxiety is useful in clinical routine and helps to decide on therapeutic interventions.

Effect of pre-operative patient anxiety on post-spinal shivering during elective cesarean delivery: a prospective observational study

BackgroundPreoperative anxiety is an unpleasant state of tension that may impact patients’ post-operative pain and satisfaction. The level of preoperative anxiety should be routinely identified. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-reported questionnaire that is used to quickly assess preoperative anxiety and information needs with good psychometric properties.ObjectivesTo validate the Chinese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and to explore coping strategies used by patients in dealing with surgery and anesthetic.MethodsThe cross-cultural validation of APAIS involved the translation of a Chinese version of APAIS and an investigation of its psychometric properties and clinical applicability. Forward-back translation and a pilot study were performed to produce a Chinese adaptation of APAIS. The inpatients of the orthopedic, otolaryngology, and general surgery department scheduled for general anesthesia surgery were enrolled to complete psychometric testing. The reliability was assessed using Cronbach’s alpha. Exploratory factor analysis and confirmatory factor analysis were calculated to assess construct validity. The criteria validity was analyzed using the correlation between APAIS and State-trait anxiety inventory-state (STAI-S) and Visual analogue scale-anxiety (VAS-A). Coping styles were evaluated using the Medical Coping Modes Questionnaire (MCMQ) score that covered three domains: confrontation, avoidance, and resignation. The impact of different coping styles on patients’ anxiety was explored.ResultsA total of 204 valid questionnaires were collected the day before surgery. Cronbach’s alpha coefficients were 0.862 for the anxiety scale and 0.830 for the information scale. Exploratory factor analysis with oblique rotation revealed two factors that explained 76.45% of the total variances. A confirmatory factor analysis showed a two-factor model with an adequate model fit (root mean square error of approximation: 0.073, goodness-of-fit: 0.966). The APAIS anxiety score significantly correlated with STAI-S (r = 0.717, P < 0.01) and VAS-A (r = 0.720, P < 0.01). For the three coping strategies, preoperative anxiety had a low correlation with confrontation (r = 0.33, P < 0.01) and resignation (r = 0.22, P < 0.05).ConclusionsThe Chinese version of APAIS is a valid and reliable instrument for assessing preoperative anxiety. Use of this measurement tool for Chinese patients is feasible and shows promising results.

BackgroundPreoperative anxiety is a frequent and challenging problem that may impact a patient's postoperative pain and satisfaction. The level of a patient's anxiety needs to be assessed through a valid and reliable instrument to prevent and treat preoperative anxiety effectively. One such reliable measurement scale is Amsterdam Preoperative Anxiety and information scale, which is based on a self-reported questionnaire but is still not validated in Arabic.ObjectiveTo validate the Arabic Version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) for assessing preoperative anxiety in the Arabic population.MethodsA cross-sectional study was conducted to translate and evaluate the validity of the APAIS in the Arabic version. The targeted population was Saudi adults undergoing surgery at the King Fahad Hospital in the Qassim region of Saudi Arabia. One hundred hospital patients were recruited and given the APAIS questionnaire to collect the data. The ethical considerations have been appropriately followed to protect the privacy of the patient's history. The collected data was qualitative and quantitative, which were analyzed using Statistical Package for the Social Sciences (SPSS).ResultsThe questionnaire showed high internal consistency on the anxiety scale (Cronbach's alpha: 0.851) and a strong correlation between age, chronic diseases, and surgery. While Cronbach's alpha for the information scale is 0.827. The gold standard curve between the worried and afraid two variables showed good efficiency during the configuration. In addition, the Confirmatory Factor Analysis (CFA) model of the Arabic version is a two-factor model to evaluate the validity of the Arabic version.ConclusionThe Arabic Version of the Amsterdam Preoperative Anxiety and information scale (APAIS) is a valid and reliable instrument for assessing preoperative anxiety. Using this validated scale for Arabic patients is feasible and shows promising results.

Background: Pre-operative anxiety in obese patients is expected to be more due to psychological reasons, body habitus, comorbidities, and fear of not waking up from anesthesia. It is associated with emotional and physical problems. Predictive factors are complexity of surgery, the anesthesia, post-operative pain, not being appropriately informed, and psychosocial characteristics of the patient. Not many such studies have been conducted in morbidly obese patients. Objectives: The objective of this study was to determine the correlation between pre-operative anxiety and post-operative pain in obese patients undergoing elective laparoscopic bariatric surgery. Methods: Total 200 patients of the American Society of Anesthesiologists Grade I–III were taken, with BMI &gt;30 kg/m2, who were undergoing elective laparoscopic bariatric surgeries. The amsterdam preoperative anxiety and information scale (APAIS) score was recorded a day prior to surgery. Heart rate, blood pressure, respiratory rate, and SpO2 were recorded pre- and postoperatively. Patients were assessed for pain on the visual analog scale (VAS) in post-operative period at 0-, 1-, 2-, 6-, 12-, and 24-h intervals. All the data were entered in master chart and statistically analyzed (Pearson coefficient of correlation test). Results: There is a positive, weak, statistically significant correlation (r=0.157, p=0.026) between anxiety score (APAIS) and post-operative pain (the highest VAS across all hours). Conclusion: Pre-operative anxiety is directly linked to post-operative pain in obese patients undergoing elective laparoscopic bariatric surgery.

Ureteral stones are a common urological disorder that often requires surgical intervention. However, preoperative anxiety is a prevalent issue among surgical patients and can negatively affect their postoperative recovery. As a form of nursing intervention, preoperative visits have been shown to effectively alleviate preoperative anxiety; However, research on their effect on patients undergoing ureteral stone surgery is limited. This study aims to assess the effect of preoperative visits on preoperative anxiety in patients undergoing ureteral stone surgery. This retrospective cohort study involved patients who underwent ureteral stone surgery at Changxing Hospital of Zhejiang Medical and Health Group between January 2022 and November 2024. The patients were divided into an observation group (48 cases) and a control group (59 cases) according to whether they received a preoperative visit. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Univariate and multivariate linear regression analyses were used to evaluate the effect of preoperative visits. The observation group showed significantly lower total anxiety scores, total information demand scores and overall APAIS scores 48 hours before surgery compared with the control group (p < 0.05 for all). Multivariate regression analysis revealed that preoperative visits had a significant impact on the APAIS anxiety score (β = -1.560, p < 0.001), APAIS information demand score (β = -1.058, p = 0.002) and overall APAIS score (β = -2.610, p < 0.001). Female patients, rural residents and patients with low education levels had high anxiety scores and may require additional support. Preoperative visits are effective in reducing preoperative anxiety in patients undergoing ureteral stone surgery, particularly for female patients, rural residents and those with low educational levels. Preoperative visits should be widely implemented in clinical practice.

Objective To determine the reliability and validity of the Chinese edition of the Amsterdam preoperative anxiety and information scale (APAIS) for the assessment of preoperative anxiety of Chinese patients. Methods The APAIS was translated into Chinese version. One hundred and thirty patients undergoing elective surgery were enrolled to complete the APAIS, STAI-S, VAS-A at the day before surgery, and thirty subjects received a re-test of APAIS at the day of surgery. Results The average score of Chinese version of APAIS anxiety scale and information scale were (7.37±3.51) and (3.67±1.94), respectively. Cronbach α for the anxiety scale was 0.84 and information scale was 0.78, respectively. Test-retest reliability were r=0.746(P<0.01) and r=0.655(P<0.01), respectively. Factor analysis showed anxiety and the desire for information were found, which explained 73.82% of variance. The anxiety scale of APAIS significantly correlated with STAI-S and VAS-A, Correlation Coefficient were r=0.720(P<0.01) and r=0.641(P<0.01), respectively. Conclusion The Chinese version of the APAIS has good reliability and validity to quick measure the preoperative anxiety and desire for information of patients. Key words: Amsterdam preoperative anxiety and information scale; Preoperative anxiety; Reliability; Validation

Preoperative anxiety is a major problem in patients with brain tumors and is of high clinical relevance. However, to date no instruments have been validated for the assessment of preoperative anxiety for this patient group. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) has shown promising results for the assessment of preoperative anxiety. The aim of this study was to determine its psychometric properties and the optimal cutoff score for patients with intracranial tumors to make it applicable in the neurosurgical setting. The sample totaled 180 neurosurgical patients with intracranial tumors. Patients were administered the APAIS along with the Hospital Anxiety and Depression Scale as the gold standard against which the APAIS was compared. Patients scoring 11 or above in the anxiety subscale of the Hospital Anxiety and Depression Scale were defined as clinical cases having anxiety. The psychometric properties of the APAIS were evaluated for a postulated 2-factor structure, Cronbach α, and correlations. The postulated 2-factor structure could not be replicated. Instead, we found a 3-factor solution (anxiety about the operation, anxiety about the anesthesia, information requirement). The area under the receiver operating characteristics curve ranged from ≥0.65 to ≥0.77. Optimal cutoff scores were calculated. The cutoff score for the anxiety scale was ≥10 for the whole sample and men only, and was ≥11 for women only. Analysis of the psychometric properties yielded satisfactory results (eg. Cronbach α for the anxiety scale >0.84). Despite its brevity, the APAIS is valid and recommendable for the assessment of preoperative anxiety in patients with intracranial tumors. As this is the first validation study focusing on patients with severe diseases and major surgeries, we recommend the application of our cutoff scores also for patients similar to our study population with regard to disease and surgery severity.

BackgroundThe correlation and influencing factors of preoperative anxiety, postoperative pain, and delirium in elderly patients undergoing gastrointestinal cancer surgery were explored with the Beck Anxiety Inventory (BAI) scale, 10-point Visual Analogue Scale (VAS), and Confusion Assessment Method Chinese Reversion (CAM-CR) scale.MethodsA total of 120 patients aged 65 years old who receiving gastrointestinal cancer surgery were enrolled in the study. Perioperative anxiety, pain, and delirium were assessed by the BAI scale, VAS scale, and CAM-CR scale, respectively. The correlation and influencing factors of preoperative high anxiety, postoperative high pain, and postoperative delirium were analyzed.ResultsPreoperative high anxiety had a moderate positive correlation with postoperative high pain (P < 0.001, r = 0.410), and had a weak positive correlation with postoperative delirium (P = 0.005, r = 0.281). postoperative high pain had a weak positive correlation with postoperative delirium (P = 0.017, r = 0.236). Type of cancer and surgical approach were considered to be independent risk factors of preoperative high anxiety (P = 0.006 and P = 0.021). Preoperative high anxiety was considered to be an independent risk factor of postoperative high pain (P< 0.001). Age and preoperative high anxiety were considered to be independent risk factors of postoperative delirium (P< 0.001 and P = 0.010).ConclusionsElderly patients undergoing gastrointestinal cancer surgery had a higher incidence of preoperative anxiety, as well as first-day postoperative pain and first-day postoperative delirium. Factors such as type of cancer, surgical approach and preoperative anxiety had been identified as influencing preoperative anxiety levels; preoperative anxiety had been linked to postoperative pain; and age and preoperative anxiety have been identified as influencing factors of postoperative delirium.Trial registrationhiCTR2000032008, 17/04/2020, Title: “Effects of different analgesic methods on postoperative recovery of elderly patients with digestive tract tumor”. Website: https://www.chictr.ogr.cn.

PAS-7 is Superior to APAIS for Assessing Preoperative Anxiety in the Chinese Population

Association between preoperative anxiety and postoperative pain and stiffness after anterior cruciate ligament reconstruction: a retrospective, single-center study.

BackgroundPreoperative anxiety is a common sensation experienced by patients undergoing surgical interventions. It can influence intraoperative and postoperative management through the activation of the neuroendocrine system, leading to tachycardia, hypertension, pulmonary complications, higher consumption of anesthetic drugs, and increased postoperative pain. Our aim was to investigate the level of preoperative anxiety during the COVID-19 pandemic; we also compared it to the preoperative anxiety of a historical cohort before the outbreak.MethodsThis is a single-center observational study. We enrolled 314 patients during the pandemic from May 2021 to November 2021, and our historical cohort consisted of 122 patients enrolled from July 2015 to May 2016 in the university hospital “Federico II” of Naples. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the State-Trait Anxiety Inventory (STAI) were used to evaluate preoperative anxiety. In particular, APAIS measures preoperative anxiety and the need for information, and STAI assesses state and trait anxiety through STAI-Y1 and STAI-Y2, respectively. We analyzed APAIS and STAI scores in our population stratified on the basis of age, gender, marital status, previous surgical experiences, and type of surgery, and we compared them to our historical cohort. Statistical analysis was performed through a t-test and ANOVA for parametric data, and the Mann–Whitney and Kruskal–Wallis tests for non-parametric data. Linear regression was used to investigate the correlation between demographic data and the scores of STAI and APAIS in both groups.ResultsOur results showed that state and preoperative anxiety remained stable, whereas trait anxiety increased in all the subgroups analyzed.DiscussionEven if state anxiety is considered a variable characteristic of the emotional sphere and trait anxiety a stable element, our findings suggested that COVID-19 deeply influenced trait anxiety, thus altering the patients’ psychological foundations.

Background: Depression and anxiety experienced before major cancer surgeries have been associated with postoperative morbidity and mortality. Objectives: This study aimed to estimate the prevalence of preoperative anxiety and depression in patients undergoing major oncosurgeries. Materials and Methods: This was a cross-sectional analytical study conducted between June 2021 and June 2022 at Malabar Cancer Center in Thalassery, Kerala, in South India. We enrolled patients aged 18–65 years undergoing major oncosurgeries with American Society of Anesthesiologists (ASA) Physical Status Grades I and II. Patients were administered a questionnaire (in the local language, Malayalam) by the anesthesiologist on their first preoperative visit after the preanesthetic checkup. The questionnaire was in two parts: part 1 consisted of the demographic data, and part 2 comprised the Patient Health Questionnaire-4 (PHQ-4) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). On the PHQ-4, a score of ≥3 for the first two questions was the cutoff for anxiety, and a score of ≥3 for the last two questions was the cutoff for depression. APAIS is a six-item questionnaire; a score of ≥11 on the anxiety scale was considered positive for anxiety, and a score of &gt;5 was considered to indicate the need for more information. Results: We enrolled 200 patients; 136 (68%) were women, and the median age overall was 52 (interquartile range [IQR], 42–60). Patients enrolled were planned for surgeries for head-and-neck cancers (n = 55, 27.5%), laparotomies or therapeutic laparoscopies (n = 70, 35%), breast cancers (n = 67, 33.5%), and bone and soft tissue surgeries (n = 8, 4%). Anxiety was noted in 49 (24.5%) patients by PHQ-4 and 23 (11.5%) patients by APAIS; depression was detected in 31 (15.5%). The presence of depression significantly contributed to anxiety. Patients who screened positive for depression had 79.6 times higher odds of screening positive for anxiety, as compared to those who screened negative for depression. Conclusion: Almost one in four patients undergoing major oncosurgeries experience preoperative anxiety, and one in six have depression. Patients have a substantial requirement for information concerning anesthesia and surgical procedures, which, if unmet, contributes to anxiety and/or depression. Preoperative counseling and providing more information to patients could reduce anxiety or depression. Other causative personal, familial, social, or economic factors should also be assessed and managed (Clinical Trials Registry of India number: CTRI/2021/07/034568).

Pancreatic cancer is one of the most lethal malignancies. Currently, the only treatment is surgical resection, which contributes to significant preoperative anxiety, reducing quality of life and worsening surgical outcomes. To date, no standard preventive or therapeutic methods have been established for preoperative anxiety in pancreatic patients. This observational study aims to identify which patients' socio-demographic, clinical and psychological characteristics contribute more to preoperative anxiety and to identify which are their preoperative concerns. Preoperative anxiety was assessed the day before surgery in 104 selected cancer patients undergoing similar pancreatic major surgery, by administering the STAI-S (State-Trait Anxiety Inventory Form) and the APAIS (Amsterdam Preoperative Anxiety and Information Scale). Our data suggest that patients with high STAI-S showed higher levels of APAIS and that major concerns were related to surgical aspects. Among psychological characteristics, depressive symptoms and trait anxiety appeared as risk factors for the development of preoperative anxiety. Findings support the utility of planning a specific psychological screening to identify patients who need more help, with the aim of offering support and preventing the development of state anxiety and surgery worries in the preoperative phase. This highlights also the importance of good communication by the surgeon on specific aspects related to the operation.