Association of Preoperative Anxiety with Perioperative Outcomes in Adult Surgical Patients: A Cross-Sectional Study

Background Preoperative anxiety is common among surgical patients and is associated with adverse perioperative outcomes. This study aimed to determine the prevalence of significant preoperative anxiety and its association with intraoperative events, postoperative pain, recovery, and patient satisfaction. Methods A cross-sectional questionnaire-based study was conducted at a tertiary care teaching hospital from January to December 2025. Adult patients who underwent surgery under general or regional anesthesia within the previous three months were included. Preoperative anxiety was assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Perioperative variables were self-reported. Multivariate logistic regression analysis identified predictors of significant anxiety and postoperative analgesic requirement. Results Among 424 respondents (response rate 94.4%), 55.7% had clinically significant anxiety (APAIS ≥11). Female sex, age <40 years, emergency surgery, and prior negative surgical experience were independent predictors. Patients with anxiety had higher postoperative pain scores (6.4 ± 1.9 vs 4.8 ± 1.7; P <0.001) and increased likelihood of additional analgesic use (OR 2.64; 95% CI 1.75–3.98). Anxiety was also associated with delayed recovery, postoperative nausea and vomiting, sleep disturbance, and lower satisfaction (OR 2.91; 95% CI 1.74–4.85). The model showed acceptable discrimination (AUC = 0.74). Discussion The findings indicate that preoperative anxiety is a major modifiable perioperative risk factor associated with poorer postoperative recovery and patient satisfaction. Conclusion Preoperative anxiety is highly prevalent and independently associated with worse patient-reported perioperative outcomes. Routine anxiety screening may aid risk stratification and improve perioperative care.