Association Between Preoperative Anxiety Level and Increased Blood Pressure and Pulse Rate Among Surgical Patients: A Cross-Sectional Study

Annisha Dwi Pricillia Tabara; Joko Murdiyanto; Muhaji

doi:10.66763/gjmsn.v1i2.39

Authors

Annisha Dwi Pricillia Tabara Universitas ‘Aisyiyah Yogyakarta Author
Joko Murdiyanto Universitas ‘Aisyiyah Yogyakarta Author
Muhaji Universitas ‘Aisyiyah Yogyakarta Author

DOI:

https://doi.org/10.66763/gjmsn.v1i2.39

Keywords:

Anxiety, Hemodynamic Response, Perioperative Care, Preoperative Assessment, Vital Signs

Abstract

Background: Preoperative anxiety is a common psychological response among surgical patients and may be accompanied by hemodynamic changes, including increased blood pressure and pulse rate. These changes may complicate preoperative preparation and affect perioperative stability.
Objectives: This study aimed to examine the association between preoperative anxiety level and increased blood pressure and pulse rate among surgical patients.
Methods: A quantitative observational study with a cross-sectional design was conducted at PKU Muhammadiyah Yogyakarta Hospital, Indonesia. A total of 55 first-time surgical patients aged 17–59 years who were scheduled for elective surgery under general anaesthesia were selected using purposive sampling. Preoperative anxiety was assessed using the Indonesian version of the Amsterdam Preoperative Anxiety and Information Scale, while blood pressure and pulse rate were measured using a calibrated digital sphygmomanometer. Data were analysed using Spearman’s rank correlation test.
Results: Moderate anxiety was the most common category, reported by 25 participants (45.5%). Prehypertension was observed in 37 participants (67.3%), and tachycardia was identified in 36 participants (65.5%). Preoperative anxiety level was significantly and positively associated with blood pressure category (ρ = 0.654, p < 0.001) and pulse-rate category (ρ = 0.515, p < 0.001).
Conclusions: Higher preoperative anxiety levels were associated with higher blood pressure and pulse-rate categories among patients undergoing elective surgery. Routine anxiety screening alongside hemodynamic monitoring may support more comprehensive preoperative assessment and psychological preparation.

References

Abate, S. M., Chekol, Y. A., & Basu, B. (2020). Global prevalence and determinants of preoperative anxiety among surgical patients: A systematic review and meta-analysis. International Journal of Surgery Open, 25, 6–16. https://doi.org/10.1016/j.ijso.2020.05.010

Baagil, H., Baagil, H., & Gerbershagen, M. U. (2023). Preoperative anxiety impact on anesthetic and analgesic use. Medicina, 59(12), 2069. https://doi.org/10.3390/medicina59122069

Bedaso, A., & Ayalew, M. (2019). Preoperative anxiety among adult patients undergoing elective surgery: A prospective survey at a general hospital in Ethiopia. Patient Safety in Surgery, 13, 18. https://doi.org/10.1186/s13037-019-0198-0

Bedaso, A., Mekonnen, N., & Duko, B. (2022). Prevalence and factors associated with preoperative anxiety among patients undergoing surgery in low-income and middle-income countries: A systematic review and meta-analysis. BMJ Open, 12(3), e058187. https://doi.org/10.1136/bmjopen-2021-058187

Bello, C. M., Eisler, P., & Heidegger, T. (2025). Perioperative anxiety: Current status and future perspectives. Journal of Clinical Medicine, 14(5), 1422. https://doi.org/10.3390/jcm14051422

Chen, Y. Y. K., Soens, M. A., & Kovacheva, V. P. (2022). Less stress, better success: A scoping review on the effects of anxiety on anesthetic and analgesic consumption. Journal of Anesthesia, 36(4), 532–553. https://doi.org/10.1007/s00540-022-03081-4

Eberhart, L., Aust, H., Schuster, M., Sturm, T., Gehling, M., Euteneuer, F., & Rüsch, D. (2020). Preoperative anxiety in adults: A cross-sectional study on specific fears and risk factors. BMC Psychiatry, 20, 140. https://doi.org/10.1186/s12888-020-02552-w

Hall, J. E. (2021). Guyton and Hall textbook of medical physiology (14th ed.). Elsevier.

Jovanovic, K., Kalezic, N., Sipetic Grujicic, S., Zivaljevic, V., Jovanovic, M., Savic, M., Bukumiric, Z., Dragas, M., Sladojevic, M., Trailovic, R., Koncar, I., & Davidovic, L. (2022). Translation and validation of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) in Serbia. Brain and Behavior, 12(1), e2462. https://doi.org/10.1002/brb3.2462

Lami, M., Negash, A., Dereje, J., Hiko, A., Mesfin, S., Gebreyesus, A., Belama, N., Omer, N. A., Balis, B., & Jibro, U. (2025). Prevalence of preoperative anxiety and associated factors among surgical patients: Systematic review and meta-analysis in Ethiopia. Health Services Research and Managerial Epidemiology, 12, 11786329251316748. https://doi.org/10.1177/11786329251316748

Moerman, N., van Dam, F. S. A. M., Muller, M. J., & Oosting, H. (1996). The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesthesia & Analgesia, 82(3), 445–451. https://doi.org/10.1097/00000539-199603000-00002

Ni, K., Zhu, J., & Ma, Z. (2023). Preoperative anxiety and postoperative adverse events: A narrative overview. Anesthesiology and Perioperative Science, 1, 23. https://doi.org/10.1007/s44254-023-00019-1

Oteri, V., Martinelli, A., Crivellaro, E., & Gigli, F. (2021). The impact of preoperative anxiety on patients undergoing brain surgery: A systematic review. Neurosurgical Review, 44(6), 3047–3057. https://doi.org/10.1007/s10143-021-01498-1

Perdana, A., Fikry Firdaus, M., & Kapuangan, C. (2015). Uji validasi konstruksi dan reliabilitas instrumen The Amsterdam Preoperative Anxiety and Information Scale (APAIS) versi Indonesia. Majalah Anestesia & Critical Care, 33(1), 279–286.

Shebl, M. A., Toraih, E., Shebl, M., Tolba, A. M., Ahmed, P., Banga, H. S., Orz, M., Tammam, M., Saadalla, K., Elsayed, M., Kamal, M., Abdulla, M., Eldessouky, A. I., Moustafa, Y. T., Mohamed, O. A., & Aiash, H. (2025). Preoperative anxiety and its impact on surgical outcomes: A systematic review and meta-analysis. Journal of Clinical and Translational Science, 9(1), e33. https://doi.org/10.1017/cts.2025.6

Tadesse, M., Ahmed, S., Regassa, T., Girma, T., & Mohammed, A. (2022). The hemodynamic impacts of preoperative anxiety among patients undergoing elective surgery: An institution-based prospective cohort study. International Journal of Surgery Open, 43, 100490. https://doi.org/10.1016/j.ijso.2022.100490

Tokudome, T., & Otani, K. (2022). Molecular mechanism of blood pressure regulation through the atrial natriuretic peptide. Biology, 11(9), 1351. https://doi.org/10.3390/biology11091351

Triebel, H., & Castrop, H. (2024). The renin angiotensin aldosterone system. Pflügers Archiv - European Journal of Physiology, 476(5), 705–713. https://doi.org/10.1007/s00424-024-02908-1

Wang, R., Huang, X., Wang, Y., & Akbari, M. (2022). Non-pharmacologic approaches in preoperative anxiety, a comprehensive review. Frontiers in Public Health, 10, 854673. https://doi.org/10.3389/fpubh.2022.854673

Weiser, T. G., Haynes, A. B., Molina, G., Lipsitz, S. R., Esquivel, M. M., Uribe-Leitz, T., Fu, R., Azad, T., Chao, T. E., Berry, W. R., & Gawande, A. A. (2016). Size and distribution of the global volume of surgery in 2012. Bulletin of the World Health Organization, 94(3), 201–209F. https://doi.org/10.2471/BLT.15.159293

Woldegerima Berhe, Y., Belayneh Melkie, T., Fitiwi Lema, G., Getnet, M., & Chekol, W. B. (2022). The overlooked problem among surgical patients: Preoperative anxiety at Ethiopian University Hospital. Frontiers in Medicine, 9, 912743. https://doi.org/10.3389/fmed.2022.912743