Association between preoperative anxiety and case cancellations: Prospective study.

Area of Science:

• Anesthesiology and Perioperative Medicine
• Psychological Medicine

Background:

• Diagnosed anxiety disorders predict same-day surgical cancellations.
• Many patients experience significant preoperative anxiety without a formal diagnosis.
• Preoperative anxiety is a prevalent concern impacting surgical scheduling.

Purpose of the Study:

• To investigate if high preoperative anxiety independently predicts same-day surgical case cancellations.
• To assess the association between anxiety levels and surgical cancellations beyond known risk factors.

Main Methods:

• Prospective study at Montefiore Medical Center (April 2023 - January 2025).
• Anxiety assessed preoperatively using a 0-10 Numeric Rating Scale (NRS); high anxiety defined as NRS ≥5.
• Modified Poisson and logistic regressions adjusted for known cancellation predictors.

Main Results:

• 19.3% of 6469 cases reported high preoperative anxiety, significantly more than those with a formal diagnosis (9.5%).
• High anxiety was associated with a 1.7% increased risk of same-day cancellation (aRR 1.29, p=0.023).
• Each point increase in NRS score dose-dependently increased cancellation risk (aOR 1.04, p=0.019), with 22.1% of cancellations attributable to anxiety.

Conclusions:

• Significant preoperative anxiety affects 1 in 5 patients and independently predicts surgical cancellations.
• Preoperative anxiety is a significant, modifiable factor contributing to one-fifth of same-day cancellations.
• Preoperative interventions targeting anxiety may reduce surgical case cancellations.