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Updated: Jun 6, 2026
An Experimental Paradigm for the Prediction of Post-Operative Pain (PPOP)
Published on: January 27, 2010
Comparing two pre-operative anxiety scales for predicting postoperative pain in ambulatory surgery: Data from a
Caroline S Dahlem1, Catarina T Monteiro1, Eunice Mendes1
1From the RISE-Health, Faculty of Medicine, University of Porto, Porto, Portugal (CSD, CCO, LA, JB-E, CG), Department of Anaesthesiology, Unidade Local de Saúde Entre Douro e Vouga, Santa Maria da Feira (CSD), Centro Académico Clínico Egas Moniz Health Alliance, University of Aveiro, Aveiro (CSD), Department of Anaesthesiology, Unidade Local de Saúde Vila Nova de Gaia/Espinho, Vila Nova de Gaia (CTM, CCO), Department of Anaesthesiology, Unidade Local de Saúde de Coimbra, Coimbra (EM), Department of Anaesthesiology, Unidade Local de Saúde do Baixo Vouga, EPE, Aveiro (MB), Department of Community Medicine, Information and Health Decision Sciences - MEDCIDS, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal (LA), Institute for Medical Education, University of Bern, Bern, Switzerland (JB-E), Department of Anaesthesiology, Unidade Local de Saúde São João (CG), Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal (CG).
Background:
Pre-operative anxiety is present in most day surgery patients and is associated with increased postoperative pain. However, most anaesthetists do not objectively evaluate pre-operative anxiety. Both Surgical Fear Questionnaire (SFQ) and Anxiety Numeric Rating Scale (ANRS) are tools that can be used for standardised anxiety assessment.
Objective:
To compare the SFQ and ANRS in assessing pre-operative anxiety and predicting postoperative pain; to identify predictive factors for high pre-operative anxiety.
Study Design:
Secondary analysis of a multicentre prospective observational study.
Setting:
Three Portuguese ambulatory surgery units.PATIENTS Two hundred and ninety-six patients underwent open inguinal hernia repair between September 2018 and March 2020.
Intervention:
Patients were assessed for pre-operative anxiety using the SFQ and ANRS before surgery. Postoperative evaluations were conducted at 24 h, 7 days, 3 months and 1 year.
Main Outcome Measures:
Pre-operative anxiety and postoperative pain, Global Surgery Recovery Index and patient satisfaction.
Results:
Two hundred and fifty-four patients completed the 12-month follow-up, with 260 men and 31 women analysed. The mean pre-operative SFQ score was 21.6 ± 15.8, with cutoffs of 20/24 for predicting acute/chronic pain. The mean pre-operative ANRS score was 3.7 ± 2.5, with an optimal cutoff of 4. Patients with SFQ at least 21 had worse postoperative outcomes at all time points (P < 0.03). The SFQ could predict pain at least 4 at all analysed time points while the ANRS could only predict pain 1 year after surgery. Independent predictors of high pre-operative anxiety included younger age, female sex, BMI less than 30 and pre-operative pain score at least 4.
Conclusion:
Pre-operative anxiety evaluation allows for the identification of patients at a high risk for postoperative complications. Both instruments demonstrated some ability to predict postoperative pain and might be valuable in the pre-operative setting, with the SFQ showing better performance.
Trial Registration:
NCT03499730.
