Background: Preoperative anxiety significantly impacts patient outcomes and healthcare delivery, with varying degrees of prevalence reported globally. Understanding and managing this anxiety are crucial for improving surgical experiences and patient recovery. This study focuses on tertiary care hospitals in Karachi, aiming to elucidate the frequency and determinants of preoperative anxiety among elective surgery patients. Objective: To ascertain the prevalence of preoperative anxiety among patients awaiting elective surgeries in various surgical units of tertiary care hospitals in Karachi and to identify significant contributing factors. Methods: In a prospective cross-sectional design, 400 patients scheduled for elective surgeries across six surgical units were assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). SPSS version 24 facilitated the analysis, focusing on global anxiety prevalence and its associations with demographic and clinical variables. Results: The study revealed a 62.0% prevalence of preoperative global anxiety. The APAIS scores indicated higher anxiety related to the surgery (mean = 7.27 ± 2.31) compared to anesthesia (mean = 5.14 ± 2.35). Significant associations were found between anxiety levels and age groups (p=0.002), surgical procedures (p<0.001), and type of anesthesia (p<0.001). ENT and urology patients exhibited notably higher anxiety, at 75.0% and 68.0% respectively. Multivariate analysis demonstrated a significant impact of gender on preoperative anxiety, with females showing increased vulnerability [aOR 1.91 (95% CI 1.13-3.21); p=0.015]. Conclusion: Preoperative anxiety remains a prevalent concern, with female patients exhibiting higher levels of anxiety than their male counterparts. The findings advocate for targeted counseling and informational support for patients, especially females, prior to surgery and anesthesia consultations, underscoring the need for healthcare professionals to address and mitigate preoperative anxiety effectively.