Predictors of pre-operative anxiety in urological surgery: a prospective single-center study

To assess preoperative anxiety levels in patients undergoing urological surgery and identify predictors of increased anxiety.

A prospective, single-center study enrolled 200 patients from May 2022 to December 2024, who completed the Hospital Anxiety and Depression Scale (HADS) questionnaire after consulting a urologist. Multivariable logistic regression was used to analyze associations with anxiety levels.

Participants had a median age of 55 years (males) and 52 years (females); 70% were male. Most were married (67%) and had > 12 years of education (89%). Anxiety or depression history was reported in 16.5%, and 65.5% had prior surgeries. Urological malignancies accounted for 29.5% of procedures. Median HADS scores were 8 for males and 7 for females (p = 0.1). Male anxiety levels were 48% normal, 12% borderline and 40% abnormal, while female levels were 55% low, 15% borderline and 30% abnormal. Pre-existing anxiety was the strongest predictor of mild-to-severe anxiety (OR 11.378, 95% CI 2.434-53.195, p = 0.002). Fewer previous surgeries were inversely associated with anxiety (OR 0.762, 95% CI 0.610-0.951, p = 0.01). Other factors, including age, gender, BMI, marital status, Charlson score, and oncological procedures, were not significantly associated. Education level > 12 years showed a trend toward reduced anxiety, though not statistically significant.

Pre-existing anxiety strongly predicts preoperative anxiety. Tailored interventions should focus on addressing psychological health, particularly in patients with no prior surgical experience.