Preoperative anxiety assessment in orthopaedic surgery: a systematic review and meta-analysis

Preoperative anxiety (Pop-Anx) is highly prevalent among patients undergoing orthopaedic surgery. Pop-Anx can stem from fears related to the procedure, anaesthesia, or the recovery process. It has been linked to poorer postoperative outcomes, including greater pain, reduced function, and a lower quality of life. Despite its clinical significance, Pop-Anx is inconsistently assessed due to a lack of standardized tools and clear guidelines. The objective was to identify instruments used for measuring Pop-Anx in patients undergoing orthopaedic surgeries.

A systematic search was conducted across five databases up to September 2024, following PRISMA guidelines. Data on anxiety assessment tools, timing, administration, and related outcomes were extracted. Meta-analyses were conducted on studies with a low risk of bias using random-effects models.

Screening of the literature revealed that 42 studies assessed Pop-Anx, involving a total of 115,380 patients. Ten different tools were used to measure Pop-Anx, with the Hospital Anxiety and Depression Scale (HADS) being the most frequent. Significant variability was observed in assessment timing and methodology. A meta-analysis showed that Pop-Anx was positively correlated with postoperative anxiety (z = 0.60) and pain (z = 0.22) and negatively correlated with joint function (z = -0.25). Females reported higher Pop-Anx (g = 0.38). The timing of outcome assessment did not significantly moderate these relationships.

Although Pop-Anx is associated with worse postoperative outcomes, it is assessed using heterogeneous and sometimes inadequate tools. Standardized, context-specific assessment methods are needed. Despite its clinical relevance, Pop-Anx remains underassessed in some common orthopaedic procedures.