Anxiety is an emotional state of fear, nervousness, and worry about threatening events associated with the physiological alertness which is accompanied by restlessness, fatigue, problems in concentration, and muscular tension (1–3). Perioperative anxiety is described as a vague, uneasy feeling in which the exact causes are often nonspecific and unknown to the individual but known to cause the body to react with undesirable hemodynamics as a consequence of sympathetic, parasympathetic and endocrine stimulation (1–9).
Anxiety can occur in any person in the acute or chronic form and can affect the perioperative anesthetic management and overall surgical outcomes by increasing Anesthetic requirement, delayed awaking, hemodynamic derangements, postoperative pain, delaying in wound healing, impair immune system response, higher risk of infection (2, 4, 6, 10–21).
The prevalence of preoperative anxiety varies according to the types of surgery, gender, motives for surgery, and country which reaches persistently as high as 97% (22).
Studies conducted in the European region showed that the prevalence of preoperative anxiety among surgical patients varied from 27–80% where the highest was observed in Spain and the smallest was in Holland (11, 23–26).
Studies conducted in India revealed that the prevalence of preoperative anxiety was varied from 47–70.3% (27–29) while the prevalence of preoperative anxiety in Pakistan was ranged from 62–97% (16, 22, 30).
Studies done in the United States of America showed that the prevalence of preoperative anxiety was as high as 20.2% (31, 32) while the prevalence of preoperative anxiety in Brazil was 24%(33).
Prevalence of preoperative anxiety among surgical patients in Ethiopia was very which varied from 47–70.3%(21, 34–36) and other studies in Africa; Nigeria and Tunisia showed that the prevalence of preoperative anxiety was 51 to 90%(10, 37, 38) and 67.5% respectively(39).
Literature mentioned that preoperative anxiety depends on age, gender, marital status, educational level, fear of postponed of surgery, types of surgery, fear of anesthesia, fear of surgery, fear of awakening in the middle of surgery, financial loss, fear postoperative pain, fear of death and fear of unknown origin(2, 4, 6, 12, 25, 33, 35, 36, 38–47). However, the leading cause of preoperative anxiety frequently mentioned in the literature was the outcomes of surgery which accounted for (29.3%) followed by fear of postoperative course (19.5%) and complications during/after the procedure (11.4%)(48).
The impacts of preoperative anxiety are numerous which includes acute myocardial infarction, heart failure, pulmonary edema, high readmission rate, poor quality of life and high rate of cardiac mortality which correlate with high postoperative pain, increased analgesic and anesthetic consumption, prolonged hospital stay, adverse influence during anesthetic induction and patient recovery and decrease patient satisfaction with perioperative care(2–5, 7, 12, 13, 25, 40–42, 44, 45, 48–58).
Mortality and morbidity associated with preoperative anxiety are more likely due to major cardiovascular problems associated with health-related behaviors such as smoking, poor diet, poor compliance with treatment, or an inactive lifestyle and direct influence on the myocardial perfusion, autonomic nervous system regulation, platelet activation, increased hypothalamus-pituitary-adrenal axis activity and exaggerated inflammatory processes(3, 4, 7, 8, 12, 13, 17, 26, 41, 44, 45, 50, 51, 57, 59–64). However, the body of evidence on global prevalence and determinates of preoperative anxiety among surgical patients is still in demand. Therefore, this Systematic Review and Meta-analysis is intended to provide evidence on global prevalence and determinates of preoperative anxiety among surgical patients.