Document Type : Original Article

Authors

1 Department of Anesthesiology and Pain Medicine, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Urology, Kerman University of Medical Sciences, Kerman, Iran

3 Department of Orthopedic Surgery, Kerman University of Medical Sciences, Kerman, Iran

Abstract

BACKGROUND: Although surgical techniques have been improving, preoperative anxiety is still
a challenge in preoperative care and is known as an expected response experienced by patients
waiting to undergo surgery. The present study aimed to compare preoperative anxiety levels in three
educational hospitals in Kerman.
MATERIALS AND METHODS: This cross‑sectional study was conducted in three educational
hospitals in Kerman, Iran, from December 2017 to May 2018. The participants were 100 patients from
each hospital (300 patients in sum) who were selected through the convenience sampling method.
Sampling was not restricted to sex and type of surgery. The 40‑item Spielberger State‑Trait Anxiety
Inventory was administered to the patients to assess the level of preoperative anxiety experienced
by them. Bivariate linear regression models were used to compare the preoperative state anxiety
levels based on the patients’ demographic information. A multivariate linear regression model was
used to determine the predictors of preoperative state anxiety.
RESULTS: The participants were 149 males and 151 females with a mean age of 36.38 (12.75)
years (age range: 12–79 years). Almost two‑third of the patients showed upper‑middle symptoms
of state anxiety (n = 197, 65.7%) followed by upper‑middle symptoms of trait anxiety (40% and
49.3%, respectively). There was a significant relationship between the patient’s sex and state
anxiety (P = 0.05) and also between trait anxiety and state anxiety (P ≤ 0.001). It was shown that
train anxiety could predict state anxiety before surgery (B: 0.53, 95% confidence interval: 0.44, 0.62;
P ≤ 0.001).
CONCLUSION: The results of the present study confirmed the presence of preoperative anxiety in
a sample of Iranian patients. Although the anxiety scores were not very high, organizing intervention
and training programs to control and reduce preoperative anxiety among patients seems essential.

Keywords

  1. World Health Organization. Mental Health: A State of Well‑Being;
    2014. Available from: http://www.who.int/features/factfiles/
    mental_health/en/aJ.
    2. Zarafshan H, Mohammadi MR, Salmanian M. Prevalence of
    anxiety disorders among children and adolescents in Iran:
    A systematic review. Iran J Psychiatry 2015;10:1‑7.
    3. Kalogianni A, Almpani P, Vastardis L, Baltopoulos G, Charitos C,
    Brokalaki H. Can nurse‑led preoperative education reduce anxiety
    and postoperative complications of patients undergoing cardiac
    surgery? Eur J Cardiovasc Nurs 2016;15:447‑58.
    4. Ali A, Altun D, Oguz BH, Ilhan M, Demircan F, Koltka K.
    The effect of preoperative anxiety on postoperative analgesia
    and anesthesia recovery in patients undergoing laparascopic
    cholecystectomy. J Anesth 2014;28:222‑7.
    5. Pokharel K, Bhattarai B, Tripathi M, Khatiwada S, Subedi A.
    Nepalese patients’ anxiety and concerns before surgery. J Clin
    Anesth 2011;23:372‑8.
    6. Pittman S, Kridli S. Music intervention and preoperative anxiety:
    An integrative review. Int Nurs Rev 2011;58:157‑63.
    7. Bailey L. Strategies for decreasing patient anxiety in the
    perioperative setting. AORN J 2010;92:445‑57.
  2. 8. Khalili N, Karvandian K, Ardebili HE, Eftekhar N, Nabavian O.
    Predictive factors of preoperative anxiety in the anesthesia clinic:
    A survey of 231 surgical candidates. Arch Anesth Crit Care
    2019;5:21-34.
    9. 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;23:235‑40.
    10. Matthias AT, Samarasekera DN. Preoperative anxiety in surgical
    patients – Experience of a single unit. Acta Anaesthesiol Taiwan
    2012;50:3‑6.
    11. Mosadeghrad AM, Esfahani P, Nikafshar M. Hospitals’ efficiency
    in Iran: A systematic review and meta‑analysis of two decades of
    research. J Payavard Salamat 2017;11:318‑31.
    12. Sigdel S. Perioperative anxiety: A short review. Glob Anesth
    Perioper Med 2015;1(4):107-8.
    13. Basirat Z, Pasha H, Esmailzadeh S, Faramarzi M. Evaluation of the
    female sexual dysfunction in a sample of iranian infertile women.
    J Adv Med Med Res 2014;4:5825‑38.
    14. Mortazavi F. Validity and reliability of the Farsi version of
    Wijma delivery expectancy questionnaire: An exploratory and
    confirmatory factor analysis. Electron Physician 2017;9:4606‑15.
    15. 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.
    16. Kim WS, Byeon GJ, Song BJ, Lee HJ. Availability of preoperative
    anxiety scale as a predictive factor for hemodynamic changes during
    induction of anesthesia. Korean J Anesthesiol 2010;58:328‑33.
    17. Kil HK, Kim WO, Chung WY, Kim GH, Seo H, Hong JY.
    Preoperative anxiety and pain sensitivity are independent
    predictors of propofol and sevoflurane requirements in general
    anaesthesia. Br J Anaesth 2012;108:119‑25.
    18. Vergara‑Romero M, Morales‑Asencio JM, Morales‑Fernández A,
    Canca‑Sanchez JC, Rivas‑Ruiz F, Reinaldo‑Lapuerta JA. Validation
    of the Spanish version of the Amsterdam Preoperative Anxiety
    and Information Scale (APAIS). Health Qual Life Outcomes
    2017;15:120.
    19. Spalding NJ. Reducing anxiety by pre-operative education: Make
    the future familiar. Occup The Int 2003;10:278‑93.
    20. Guzinska K, Kupc A, Borys BZ. Resources resistance to stress
    in the recovery process in patients with ischemic heart disease.
    Psychiatry 2007;4:144‑52.
    21. Celik F, Edipoglu IS. Evaluation of preoperative anxiety and fear
    of anesthesia using APAIS score. Eur J Med Res 2018;23:41.
    22. Mavridou P, Dimitriou V, Manataki A, Arnaoutoglou E,
    Papadopoulos G. Patient’s anxiety and fear of anesthesia: Effect
    of gender, age, education, and previous experience of anesthesia.
    A survey of 400 patients. J Anesth 2013;27:104‑8.
    23. Rodrigues HF, Furuya RK, Dantas RAS, Rodrigues AJ,
    Dessotte CAM. Association of preoperative anxiety and
    depression symptoms with postoperative complications of cardiac
    surgeries. Rev Lat Am Enfermagem 2018;26:e3107.
    24. McLean CP, Asnaani A, Litz BT, Hofmann SG. Gender differences
    in anxiety disorders: Prevalence, course of illness, comorbidity
    and burden of illness. J Psychiatr Res 2011;45:1027‑35.
    25. Marques AA, Bevilaqua MC, da Fonseca AM, Nardi AE, Thuret S,
    Dias GP. Gender Differences in the Neurobiology of Anxiety:
    Focus on Adult Hippocampal Neurogenesis. Neural Plast
    2016;2016:5026713.
    26. Jawaid M, Mushtaq A, Mukhtar S, Khan Z. Preoperative anxiety
    before elective surgery. Neurosciences (Riyadh) 2007;12:145‑8.
    27. Jafar MF, Khan FA. Frequency of preoperative anxiety in Pakistani
    surgical patients. J Pak Med Assoc 2009;59:359‑63.
    28. Mulugeta H, Ayana M, Sintayehu M, Dessie G, Zewdu T.
    Preoperative anxiety and associated factors among adult surgical
    patients in Debre Markos and Felege Hiwot referral hospitals,
    Northwest Ethiopia. BMC Anesthesiol 2018;18:155.
    29. Sadati L, Pazouki A, Mehdizadeh A, Shoar S, Tamannaie Z,
    Chaichian S. Effect of preoperative nursing visit on preoperative
    anxiety and postoperative complications in candidates for
    laparoscopic cholecystectomy: A randomized clinical trial. Scand
    J Caring Sci 2013;27:994‑8.
    30. Rosiek A, Kornatowski T, Rosiek‑Kryszewska A, Leksowski Ł,
    Leksowski K. Evaluation of stress intensity and anxiety level
    in preoperative period of cardiac patients. Biomed Res Int
    2016;2016:1-8.
    31. Sharifirad G, Ghaffari M, Zanjani S, Hassanzadeh A. The
    effectiveness of educational intervention based on PRECEDE
    model on the level of stress among the elderly at elderly clubs.
    J Educ Health Promot 2013;2:3.
    32. Hintistan S, Cilingir D, Pekmezci H. Assessment of death anxiety
    among medical and surgery clinics patients of a teaching hospital.
    J Pak Med Assoc 2016;66:823‑8.