Association between preoperative anxiety and case cancellations: Prospective study

Diagnosed anxiety disorder is a predictor of same-day case cancellations. Many patients experience significant preoperative anxiety without a formal diagnosis. We investigated whether high preoperative anxiety independently predicts same-day case cancellations beyond established risk factors.

This prospective study was conducted at Montefiore Medical Center between April 2023 and January 2025. Anxiety was assessed one day preoperatively using a self-reported Numeric Rating Scale (NRS:0-10). High anxiety was defined as NRS ≥5. The primary outcome was same-day case cancellation. We used modified Poisson and logistic regressions to examine associations between exposure and outcome, adjusting for known predictors of same-day case cancellation.

The final cohort included 6469 cases, of which 1248 (19.3%) reported high preoperative anxiety whereas only 9.5% of them had a documented anxiety diagnosis. The most frequently reported concerns were complications in surgery (1147 (17.7%)), postoperative complications (811 (12.5%)), and pain (682 (10.5%)). Same-day case cancellation rates were 6.0% (312/5221) for patients with low anxiety and 7.7% (96/1248) for those with high anxiety (risk difference 1.7% (95%CI (confidence interval): 0.1% -3.3%), p = 0.025). The attributable risk fraction of high anxiety for same-day case cancellation amounted to 22.1%. High anxiety was associated with an increased risk of case cancellation (adjusted risk ratio 1.29; 95%CI: 1.04-1.62; p = 0.023). An increase in each NRS anxiety score (0-10) was dose-dependently associated with added risk of case cancellation (adjusted odds ratio 1.04; 95%CI: 1.01-1.08; p = 0.019).

A significant level of preoperative anxiety occurs in one out of 5 patients and is an independent predictor of surgical case cancellations. One-fifth of same-day case cancellations in patients can be attributed to preoperative anxiety, which may potentially be addressed by a preoperative intervention.