Prevalence and Associated Predictors of Preoperative Anxiety among Adult Elective Surgical Patients in a Tertiary Care Setting in Dera Ismail Khan, Pakistan: A Hospital-Based Analytical Cross-Sectional Study

Abstract

Background: Preoperative anxiety is a prevalent psychological condition affecting surgical patients, with adverse implications for perioperative outcomes, yet evidence from peripheral regions of Pakistan remains limited. This study aimed to determine the prevalence and associated predictors of preoperative anxiety among adult elective surgical patients in tertiary care hospitals of Dera Ismail Khan, Pakistan. Methods: A hospital-based analytical cross-sectional study was conducted over six months  (January 2026 to June 2026) in tertiary care hospitals of Dera Ismail Khan, Pakistan. A total of 390 adult patients undergoing elective surgical procedures. Participants were selected using convenience sampling. Data was collected using a structured questionnaire and the validated Amsterdam Preoperative Anxiety and Information Scale (APAIS). Multivariable logistic regression analysis was performed to identify independent predictors of preoperative anxiety, with statistical significance set at p < 0.05. Results: The prevalence of clinically significant preoperative anxiety (APAIS ≥11) was 57.4% (95% CI: 52.3–62.4%), with a mean APAIS score of 11.42 ± 3.87. Independent predictors included female gender (AOR = 2.10; 95% CI: 1.28–3.45), younger age 18–30 years (AOR = 1.84; 95% CI: 1.12–3.03), absence of previous surgical history (AOR = 2.82; 95% CI: 1.71–4.65), major surgery (AOR = 1.96; 95% CI: 1.18–3.25), fear of postoperative pain (AOR = 3.41; 95% CI: 2.04–5.72), and fear of not waking up after anesthesia (AOR = 2.27; 95% CI: 1.39–3.72). Fear of postoperative pain was the most prevalent concern (68.5%), and 44.1% of patients expressed high information needs. The model explained 42.1% of variance (Nagelkerke R²) and correctly classified 78.3% of cases. Conclusion: Preoperative anxiety affects more than half of elective surgical patients in this peripheral Pakistani setting. Routine anxiety screening using APAIS, structured preoperative counseling addressing specific fears, particularly pain and anesthesia safety, and improved information delivery should be integrated into perioperative care to optimize surgical outcomes.