Contents lists available at ScienceDirect Journal of Psychosomatic Research journal homepage: www.elsevier.com/locate/jpsychores A cross-sectional study on preoperative anxiety in adults ☆ H. Aust a , L. Eberhart a , T. Sturm b , M. Schuster b , Y. Nestoriuc c,d , F. Brehm b , D. Rüsch a, ⁎ a University Hospital Giessen-Marburg, Department of Anesthesia and Intensive Care, Marburg Campus, Baldingerstrasse, 35033 Marburg, Germany b Philipps-University Marburg, Biegenstraße 10, 35037 Marburg, Germany c Institute and Policlinic for Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany d Schön Clinic Hamburg-Eilbek, Dehnheide120, 20081 Hamburg, Germany ARTICLE INFO Keywords: Amsterdam preoperative anxiety and information scale (APAIS) Anxiety about anesthesia Anxiety about surgery Preoperative anxiety ABSTRACT Objective: The main objective of this study was a detailed comparison of the level of anxiety about surgery and anesthesia. Other objectives included the assessment of the prevalence and intensity of preoperative anxiety. Methods: This cross-sectional single-center survey used the validated Amsterdam anxiety and information scale (APAIS) and a modified numeric rating scale (mNRS) to assess preoperative anxiety, anxiety about surgery and anxiety about anesthesia. Prevalences and intensities of anxieties were predominantly analyzed descriptively. Results: 3200 patients were enrolled and 3087 (57% females) were analyzed. 92.6% reported preoperative anxiety according to APAIS scores. The average total APAIS anxiety score (APAIS-A-T) was 9.9 (SD 3.6). 40.5% reported high anxiety (defined as APAIS-A-T > 10). Mean anxiety about surgery (APAIS-A-Su) was higher than mean anxiety about anesthesia (APAIS-A-An): 5.5 (SD 2.1) vs. 4.3 (SD 1.9), p < 0.0001. Accordingly, more patients were substantially more afraid (score difference > 2) of surgery (642, 20.8%, 95% CI 19.4–22.3) than of anesthesia (48, 1.6%, 95% CI 1.2–2.1). Conclusion: Preoperative anxiety is still very common among adult patients scheduled to undergo an elective procedure. Therefore, it should be evaluated routinely. Anxiety about surgery and anxiety about anesthesia differ in many patients. For this reason, anxiety about surgery and anxiety about anesthesia should be assessed separately. This would allow providing a more individualized support of patients to cope with their anxiety and could require particular attention by the surgeon or the anesthetist. 1. Introduction Anxiety is an unpleasant sensation that compromises patients' comfort and well-being. A very recent observational study carried out in > 16,000 patients revealed that anxiety was most commonly re- ported as the worst aspect of the surgical episode [1]. In addition, an- xiety has been demonstrated to be associated with increased post- operative morbidity [2] and mortality [2–4]. Furthermore, it has also been shown to be an independent predictor of severe postoperative pain [5] and accordingly to be associated with increased postoperative pain [6,7]. Therefore, the detection of preoperative anxiety in patients un- dergoing an operation is of paramount importance in order to be able to alleviate it. Previous studies demonstrated that most patients scheduled to un- dergo surgery experience preoperative anxiety [8–11]. Many studies that have examined preoperative anxiety have reported on mean an- xiety levels [6,12–15] and some of these studies focused on determining the prevalence of patients with high anxiety [15–18]. However, by reporting on the prevalence of preoperative anxiety or high pre- operative anxiety and mean or median anxiety scores only, too little attention is paid to show the extent of preoperative anxiety in in- dividual patients and to present the entire spectrum of anxiety levels. Preoperative anxiety comprises both fear of surgery and fear related to anesthesia. Few studies have addressed the question whether pa- tients are more anxious about surgery or anesthesia. While two studies reported more patients to have fears related to the anesthetic [8,19], other studies found higher average levels of fear related to surgery [15,16]. In addition to these inconsistent results, there is to date no information about the spectrum of anxiety levels about surgery and anesthesia in individual patients. The Spielberger's State Trait Anxiety Inventory (STAI) and the more recently developed Hospital Anxiety and Depression Scale (HADS) are validated tools to measure and examine anxiety. The state scale of the STAI is considered to be an appropriate mean to assess preoperative anxiety [20] and has, therefore, been used most frequently to study preoperative anxiety. However, both the state scale of the STAI and the https://doi.org/10.1016/j.jpsychores.2018.05.012 Received 8 December 2017; Received in revised form 17 May 2018; Accepted 18 May 2018 ☆ This study was carried out at the Department of Anesthesia and Intensive Care, University Hospital Giessen-Marburg, Marburg Campus ⁎ Corresponding author. E-mail address: ruesch@med.uni-marburg.de (D. Rüsch). Journal of Psychosomatic Research 111 (2018) 133–139 0022-3999/ © 2018 Elsevier Inc. All rights reserved. T