review · Journal of Clinical and Translational Science
Preoperative anxiety affects 60 to 80 percent of surgical patients. This systematic review and meta-analysis synthesised evidence detailing how anxiety before an operation impacts clinical outcomes. The analysis demonstrates that preoperative anxiety is significantly associated with higher requirements for anaesthetics and analgesics, including a positive correlation with propofol consumption. Adults experiencing preoperative anxiety face an elevated risk of postoperative delirium, though this link was not observed in paediatric cases. Furthermore, anxious patients experience prolonged extubation times and slower recovery, taking longer to achieve a Modified Aldrete Score of 9. No significant association was identified between preoperative anxiety and postoperative pain. These results underline the clinical need for systematic preoperative anxiety screening and the creation of targeted interventions to improve surgical recovery.
Anxiety before surgery is widespread and directly affects surgical efficiency, medication usage, and patient recovery. Recognising these risks enables surgical teams to anticipate complications such as postoperative delirium in adults or delayed recovery times. Implementing routine screening and targeted interventions could help clinicians tailor anaesthetic doses, reduce hospital recovery bottlenecks, and improve overall patient safety during operative care.
The findings highlight an opportunity for healthcare providers and medical software developers to create standardised preoperative anxiety screening tools and clinical protocols. Because this research is a meta-analysis synthesising existing clinical data, any direct commercial applications, such as digital screening questionnaires or tailored anxiety management interventions, remain at an early concept or applied development stage and require dedicated testing in operational hospital settings.
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Background: Preoperative anxiety is a common phenomenon affecting 60-80% of surgical patients, with potential implications for surgical outcomes. Despite its prevalence, there remains a lack of consensus on its precise effects and optimal management strategies. Objective: This meta-analysis aimed to synthesize current evidence on the impact of preoperative anxiety on various surgical outcomes, including anesthetic and analgesic requirements, delirium, recovery times, and pain. Methods: We conducted a comprehensive literature search and meta-analysis of studies examining the relationship between preoperative anxiety and surgical outcomes. Standardized mean differences (SMD), correlation (COR), and odds ratios (OR) with 95% confidence intervals were calculated. Results: Our analysis revealed significant associations between preoperative anxiety and increased anesthetic requirements (SMD = 0.67, 95% CI: 0.32-1.01) and analgesic requirements (SMD = 0.89, 95% CI: 0.65-1.12). Preoperative anxiety was associated with postoperative delirium in adults (OR = 1.90, 95% CI: 1.11-3.26), unlike the pediatric population. Preoperative anxiety was associated with prolonged time to reach Modified Aldrete Score of 9 (SMD = 0.79, 95% CI: 0.50-1.07) and extubation time (SMD = 0.89, 95% CI: 0.58-1.21). Preoperative anxiety was positively correlated with propofol consumption (STAI-S COR = 0.35, 95%CI: 0.15-0.55). No significant association between preoperative anxiety and postoperative pain was found. Conclusions: This meta-analysis provides evidence for the wide-ranging effects of preoperative anxiety on surgical outcomes. The findings emphasize the need for routine preoperative anxiety screening and the development of targeted interventions. Future research should focus on long-term impacts and the effectiveness of various anxiety management strategies.
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DOI: 10.1017/cts.2025.6
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