Marital Status Supersedes Sex as the Primary Predictor of Preoperative Anxiety Among Elective Surgery Patients in Western India: A Cross-Sectional APAIS Study

Marital Status Supersedes Sex as the Primary Predictor of Preoperative Anxiety Among Elective Surgery Patients in Western India: A Cross-Sectional APAIS Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Marital Status Supersedes Sex as the Primary Predictor of Preoperative Anxiety Among Elective Surgery Patients in Western India: A Cross-Sectional APAIS Study Richa Tailor, Anupama Kumari, Sara Mary Thomas This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9236204/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 10 You are reading this latest preprint version Abstract Background Preoperative anxiety significantly impacts perioperative outcomes through neuroendocrine activation, increased anaesthetic requirements, and impaired recovery. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) provides a validated, rapid tool for identifying high-risk patients. This study aimed to determine preoperative anxiety prevalence and identify associated demographic and clinical predictors among adult patients scheduled for elective surgery using the APAIS. Methods This cross-sectional study was conducted at a tertiary care hospital in Western India (July 2023–June 2024). One hundred adults scheduled for elective surgery were recruited through systematic random sampling. The six-item APAIS was administered, with clinically significant anxiety defined as anxiety subscale score > 11. Analysis included descriptive statistics, t-tests, ANOVA, chi-square tests, correlations, and multiple regression using R version 4.5.2. Results Clinically significant anxiety prevalence was 48% (95% CI: 38.1–57.9%). Mean APAIS scores were: anxiety 11.63 ± 3.23, information 5.29 ± 1.57, total 16.93 ± 4.36. The APAIS showed good internal consistency (Cronbach α = 0.806). Significant predictors included unmarried status (Cohen d = 1.33, p < 0.001), younger age ( r = − 0.43, p < 0.001), oncological procedures (η²=0.30, p < 0.001), and higher education (η²=0.11, p = 0.031). Surgery-related anxiety exceeded anaesthesia-related anxiety (6.42 ± 1.88 vs 5.21 ± 1.81; p < 0.001; d = 0.68). Only marital status remained independently significant in multivariate analysis (B = 2.90, p = 0.002; OR = 3.90). Conclusion Nearly half of elective surgery patients experience clinically significant anxiety, with unmarried status as the strongest predictor. Routine APAIS screening can identify high-risk patients for targeted interventions. Preoperative anxiety Amsterdam Preoperative Anxiety and Information Scale Elective surgery Anaesthesia Psychological stress Perioperative care Figures Figure 1 Figure 2 Figure 3 Introduction Preoperative anxiety, defined as apprehension and heightened autonomic arousal regarding impending surgery and anaesthesia, represents an underrecognized perioperative stressor with profound implications for patient outcomes [ 1 , 2 ]. Globally, 60–80% of surgical patients experience some degree of preoperative anxiety, with approximately half of patients in low- and middle-income countries meeting criteria for clinically significant anxiety [ 3 ]. The clinical significance extends beyond psychological distress. Anxiety-induced hypothalamic-pituitary-adrenal axis activation suppresses immune function, reduces neutrophil migration, and diminishes cytokine production, impairing wound healing and increasing infection susceptibility [ 4 – 6 ]. Anxious patients are four times more likely to experience delayed healing [ 5 ]. Preoperative anxiety also increases anaesthetic requirements, with highly anxious patients requiring 15–20% higher propofol doses (2.1 ± 0.4 vs 1.8 ± 0.3 mg/kg) [ 7 ]. Meta-analytic evidence confirms increased analgesic requirements (SMD = 1.02, 95% CI: 0.29–1.76), prolonged recovery times, and independently predicted postoperative delirium (OR = 2.03, 95% CI: 1.49–2.76) [ 8 ]. Multiple factors contribute to preoperative anxiety. A systematic review of 27 studies from low- and middle-income countries identified female gender, younger age, lower education, inadequate information, and fear of death as significant predictors [ 3 ]. Oncological and gynaecological procedures are consistently associated with elevated anxiety [ 9 , 10 ]. Female sex has emerged as an independent predictor, with women demonstrating higher APAIS anxiety scores (12.8 ± 3.9 vs 9.8 ± 3.0, p = 0.003) [ 9 ]. Indian data from Jiwanmall et al. reported 58.1% prevalence among day care surgery patients [ 11 ]. The APAIS, developed by Moerman et al. in 1996, uniquely differentiates between anxiety and information desire through six items on a 5-point Likert scale [ 12 ]. The anxiety subscale correlates highly with the State-Trait Anxiety Inventory ( r = 0.74) and completes within two minutes. Validation studies across Turkish (α = 0.897), German, Japanese, and Chinese populations confirm robust reliability and consistent two-factor structure [ 13 , 14 ]. The established cutoff of APAIS anxiety subscale > 11 identifies approximately 32% of patients as requiring intervention [ 12 ]. Despite substantial international literature, data from Indian populations remain limited. Cultural factors influencing emotional expression and family support structures may modulate anxiety responses differently in South Asian contexts. This study aimed to determine preoperative anxiety prevalence, evaluate APAIS psychometric properties, and identify predictors to inform targeted interventions at a tertiary care hospital in Western India. Materials and Methods Study Design and Setting This cross-sectional study was conducted at the Department of Anaesthesiology, Dhiraj Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India—a 1000-bed tertiary care teaching hospital. Patients were recruited over 12 months (July 2023–June 2024) from general surgery, orthopaedics, otorhinolaryngology, gynaecology, urology, oncology, and neurosurgery. Ethical Considerations The study received ethics approval (SVIEC/ON/MEDI/SRP/JUNE/23/92, approved 21 June 2023), was conducted per the Declaration of Helsinki and Good Clinical Practice guidelines, and obtained written informed consent from all participants. Sample Size Calculation Using n=Z²pq/d² with Z=1.96, p=0.48 (based on Bedaso et al. [3]), q=0.52, and d=0.10: n=(1.96)²×0.48×0.52/(0.10)²=95.8, rounded to 96. Accounting for dropouts, the target was 100 participants. Participant Selection Inclusion criteria: age ≥18 years; elective surgery under general or regional anaesthesia; ASA I–III; ability to respond in Hindi, Gujarati, or English; written informed consent. Exclusion criteria: emergency procedures; psychiatric disorders or psychotropic medication; cognitive impairment; previous adverse anaesthetic events requiring psychological intervention; consent refusal. Every third eligible patient at preanaesthetic evaluation was approached using systematic random sampling. Data Collection Instrument A structured questionnaire was administered via face-to-face interviews one day before surgery. Section A captured demographics and clinical variables: age, sex, marital status, education, surgery type, anaesthesia type, previous surgical/anaesthetic history, and family support. Section B comprised the APAIS: Items 1 and 2 assess anaesthesia-related anxiety, Items 4 and 5 assess surgery-related anxiety, and Items 3 and 6 evaluate information desire. The anxiety subscale (Items 1,2,4,5; range 4–20) and information subscale (Items 3,6; range 2–10) were calculated, with clinically significant anxiety defined as APAIS-A >11. Statistical Analysis Analysis used R version 4.5.2. Normality was assessed using Shapiro-Wilk test; reliability using Cronbach alpha (≥0.70 acceptable). Bivariate analyses included independent t-tests (with Welch correction), one-way ANOVA with Tukey HSD post-hoc, chi-square/Fisher exact tests, and Pearson correlations. Effect sizes used Cohen d (small 0.2–0.5, medium 0.5–0.8, large >0.8) and eta-squared (small 0.01–0.06, medium 0.06–0.14, large >0.14). Multivariate analyses included multiple linear regression and binary logistic regression with VIF for multicollinearity (<5 acceptable). Two-tailed p<0.05 was considered significant. Results Participant Characteristics and Anxiety Prevalence Of 108 patients screened, 100 completed the protocol (response rate 92.6%). Table 1 presents demographics and subgroup anxiety prevalence. The sample comprised 57 males and 43 females (mean age 43.97±17.63 years; range 18–80). Most were married (77%) with primary education or below (59%). General surgery was most common (25%), followed by orthopaedics (22%) and ENT (21%). Regional anaesthesia was planned for 68%, and 91% had family support. Overall anxiety prevalence was 48% (n=48, 95% CI: 38.1–57.9%) . As shown in Table 1, highest rates were observed among single patients (82.6%), those aged 18–30 (70.0%), oncology patients (100%), and higher secondary educated (85.7%). High-anxiety patients were younger (37.50±16.88 vs 49.94±16.28 years). Table 1. Baseline Demographics and Anxiety Prevalence by Subgroup (n=100) Variable Category n (%) High Anxiety n (%) Sex Male 57 (57.0) 27 (47.4) Female 43 (43.0) 21 (48.8) Age Group 18–30 years 30 (30.0) 21 (70.0) 31–45 years 24 (24.0) 15 (62.5) 46–60 years 25 (25.0) 6 (24.0) >60 years 21 (21.0) 6 (28.6) Education Illiterate 29 (29.0) 11 (37.9) Primary 30 (30.0) 14 (46.7) Secondary 25 (25.0) 11 (44.0) Higher Secondary 7 (7.0) 6 (85.7) Graduate 9 (9.0) 6 (66.7) Marital Status Married 77 (77.0) 29 (37.7) Single 23 (23.0) 19 (82.6) Type of Surgery General Surgery 25 (25.0) 5 (20.0) Orthopaedics 22 (22.0) 11 (50.0) ENT 21 (21.0) 11 (52.4) Gynaecology 16 (16.0) 12 (75.0) Urology 8 (8.0) 3 (37.5) Oncology 6 (6.0) 6 (100.0) Neurosurgery 2 (2.0) 0 (0.0) Anaesthesia Type Regional 68 (68.0) 31 (45.6) General 32 (32.0) 17 (53.1) Previous Surgery No 82 (82.0) 39 (47.6) Yes 18 (18.0) 9 (50.0) Previous Anaesthesia No 82 (82.0) 39 (47.6) Yes 18 (18.0) 9 (50.0) Family Support Yes 91 (91.0) 42 (46.2) No 9 (9.0) 6 (66.7) APAIS Score Distribution and Psychometric Properties Mean total APAIS was 16.93±4.36 (median 16.5, range 8–30). Anxiety subscale mean was 11.63±3.23 (median 11, skewness +0.36, kurtosis −0.69) and information subscale mean was 5.29±1.57 (median 5, skewness +0.52, kurtosis +0.26). Shapiro-Wilk testing indicated non-normal distributions for anxiety (W=0.962, p=0.006) and information (W=0.933, p<0.001) subscales, with borderline normality for the total score (W=0.976, p=0.059). Surgery-related items scored highest: Item 4 (concern about surgery: 3.32±1.09), Item 5 (thoughts about surgery: 3.10±1.06), Item 6 (information about surgery: 2.73±1.00), Item 1 (concern about anaesthesia: 2.68±1.12), Item 3 (information about anaesthesia: 2.57±0.87), and Item 2 (thoughts about anaesthesia: 2.53±0.94). All items were significantly higher in the high-anxiety group (all p<0.001), with Item 4 showing the largest discrimination (high 4.15±0.50 vs low 2.56±0.92; d =2.15). Cronbach alpha was 0.806 (full scale), 0.767 (anxiety subscale), and 0.578 (information subscale). All item-total correlations exceeded 0.30 (range 0.485–0.662), and deleting any item reduced alpha. Item 4 had the highest item-total correlation ( r =0.662). All 15 inter-item correlations were significant (strongest: Items 5–6, r =0.577; weakest: Items 1–6, r =0.210). Subscale correlations showed moderate anxiety–information association ( r =0.584, p<0.001), with strong subscale–total correlations (anxiety–total r =0.956; information–total r =0.797) (Figure 1). Bivariate Associations with Preoperative Anxiety Table 2 presents bivariate associations. Chi-square/Fisher exact tests showed significant associations with age group (χ²=16.784, df=3, p<0.001), marital status (χ²=14.334, df=1, p<0.001), and surgery type (Fisher p=0.001). Sex, education, anaesthesia type, previous surgery/anaesthesia, and family support were non-significant. Single patients had markedly higher anxiety than married patients, representing the study's largest effect. Younger patients (18–50) scored higher than those >50 with medium effect. Family support showed significance on equal-variance t-test (p=0.027) but not Welch-corrected test (p=0.112), which was preferred given group imbalance (n=9 vs 91). Sex, anaesthesia type, and previous surgery showed no differences. ANOVA revealed significant differences across surgical specialties (η²=0.298, large). Tukey post-hoc showed oncology patients scored significantly higher than all other groups (differences +4.15 to +7.33, all p<0.05), and gynaecology exceeded general surgery (p=0.021). Age groups differed significantly (η²=0.206, large), with 18–30 year olds higher than 46–60 (p60 (p<0.001). Education showed medium effect (η²=0.105), with graduates higher than illiterate patients (p=0.034). Age correlated negatively with anxiety ( r =−0.431, p<0.001; Spearman ρ=−0.436). Point-biserial correlations confirmed associations with single status ( r =+0.491, p<0.001) and younger age ( r =+0.296, p=0.003), but not sex ( r =+0.025, p=0.808) or previous surgery ( r =+0.062, p=0.540). Table 2. Bivariate Associations Between Variables and APAIS Anxiety Scores (n=100) Variable Group n Mean±SD Test Statistic p-value Effect Size Sex Male 57 11.56±3.39 t-test t=−0.243 0.808 d =0.05 Female 43 11.72±3.06 Chi-square χ²=0.021 0.884 Age Group (2) 18–50 64 12.34±3.24 t-test t=3.065 0.003 d =0.64 >50 36 10.36±2.84 Chi-square χ²=6.858 0.009 Age Group (4) 18–30 30 13.63±3.21 ANOVA F(3,96)=8.298 60 21 9.95±3.04 Marital Status Single 23 14.52±3.12 t-test t=−5.582 <0.001 d =1.33 Married 77 10.77±2.74 Chi-square χ²=14.334 <0.001 Education Illiterate 29 10.62±3.38 ANOVA F(4,95)=2.778 0.031 η²=0.105 Primary 30 11.47±3.09 Secondary 25 11.60±2.52 Higher Secondary 7 13.43±2.44 Graduate 9 14.11±4.20 Type of Surgery General Surgery 25 9.72±1.88 ANOVA F(6,93)=6.586 <0.001 η²=0.298 Neurosurgery 2 9.50±2.12 Urology 8 10.00±3.34 ENT 21 11.95±2.96 Orthopaedics 22 12.09±3.38 Gynaecology 16 12.69±2.85 Fisher exact — 0.001 Oncology 6 16.83±2.14 Anaesthesia Type General 32 12.38±3.35 t-test t=1.593 0.114 d =0.34 Regional 68 11.28±3.14 Chi-square χ²=0.495 0.482 Previous Surgery Yes 18 12.06±3.90 t-test t=−0.615 0.540 d =0.16 No 82 11.54±3.09 Chi-square χ²=0.035 0.851 Family Support No 9 13.89±4.11 Welch t t=1.765 0.112 d =0.78 Yes 91 11.41±3.07 Fisher exact — 0.305 Surgery versus Anaesthesia Anxiety Components Surgery-related anxiety (Items 4+5: 6.42±1.88) significantly exceeded anaesthesia-related anxiety (Items 1+2: 5.21±1.81). Both paired t-test (t(99)=6.788, p<0.001, d =0.679) and Wilcoxon signed-rank test (V=2548, p<0.001) confirmed this difference, as paired differences were non-normal (Shapiro-Wilk W=0.954, p=0.002). The mean difference was 1.21±1.78 (range −4 to +6). Anxiety dominance classification showed 62% surgery-dominant (n=62), 24% equal (n=24), and 14% anaesthesia-dominant (n=14) (Figure 2). Anxiety–Information Relationship and Discordance Profiles Anxiety and information subscales were moderately correlated ( r =0.594, p<0.001, R²=0.352), holding within both high-anxiety ( r =0.432, p=0.002) and low-anxiety ( r =0.366, p=0.008) subgroups. All 8 patients with high information need (score ≥8) had high anxiety; no low-anxiety patient showed high information need. Median-split discordance profiles revealed: high anxiety/high information (32%), low anxiety/low information (36%), high anxiety/low information (16%), and low anxiety/high information (16%). The 16% with high anxiety but low information desire represent a subgroup requiring different intervention approaches. Information Subscale Analysis Mean information score was 5.29±1.57; only 8% had high information need. Information scores were driven by clinical factors: surgery type (F(6,93)=15.011, p<0.001; oncology 8.67±1.21, general surgery 3.92±0.81), anxiety category (high 6.06±1.56 vs low 4.58±1.21; p<0.001), previous surgery (yes 6.22±2.10 vs no 5.09±1.36; p=0.040), and anaesthesia type (general 5.81±1.73 vs regional 5.04±1.44; p=0.034). Age ( r =−0.078, p=0.442), education (F(4,95)=2.102, p=0.087), sex, marital status, and family support were non-significant. Multivariate Analysis Table 3 presents regression results. Linear regression yielded R²=0.318, adjusted R²=0.282, F(5,94)=8.786, p<0.001. Only marital status was independently significant; age, sex, and family support showed non-significant trends. All VIFs were <2. Logistic regression showed overall significance (LR χ²=18.084, df=4, p=0.001; McFadden R²=0.131; AIC=130.39), with single patients having nearly four-fold higher odds (OR=3.90), though borderline Wald significance (p=0.066) likely reflects sample size. Classification accuracy was 68.0% (sensitivity 47.9%, specificity 86.5%) (Figure 3). Table 3. Multivariate Regression Analyses (n=100) Predictor Linear Regression Logistic Regression B SE β t p B OR 95% CI p (Intercept) 11.762 1.132 — 10.395 <0.001 0.660 — — 0.418 Age −0.036 0.021 −0.194 −1.725 0.088 −0.025 0.975 0.945–1.007 0.124 Sex (Female) 1.092 0.592 0.168 1.846 0.068 — — — — Marital Status (Single) 2.903 0.915 0.380 3.174 0.002 1.360 3.896 0.915–16.584 0.066 Anaesthesia (General) 0.425 0.618 0.062 0.687 0.494 0.128 1.136 0.433–2.983 0.796 Family Support (No) 1.761 0.977 0.157 1.802 0.075 0.492 1.636 0.327–8.180 0.549 Model Fit R²=0.318 Adj R²=0.282 F(5,94)=8.786 <0.001 LR χ²=18.084 df=4 McFadden R²=0.131 0.001 Linear regression: B=unstandardized coefficient, β=standardized coefficient. Logistic regression: OR=odds ratio. All VIFs <2. Sensitivity Analysis Excluding three data-entry discrepancy cases (n=97) confirmed robustness: prevalence remained 48.5%, all associations retained direction and significance, linear R² improved to 0.362, and marital status significance strengthened (p<0.001). Discussion This study revealed 48% prevalence of clinically significant preoperative anxiety among elective surgery patients in Western India, aligning with global estimates from Bedaso et al. [ 3 ] who reported 55.7% pooled prevalence across 27 low- and middle-income country studies. Our prevalence exceeds that of Lakhe et al. [ 15 ] in Nepal (22.85%), likely reflecting methodological differences, but is lower than the 58.1% reported by Jiwanmall et al. [ 11 ] among Indian day care patients, possibly due to differences in surgical complexity. Unmarried status emerged as the strongest independent predictor (14.52 ± 3.12 vs 10.77 ± 2.74, d = 1.33; OR = 3.90, 95% CI: 0.92–16.58). Marital status was the only variable retaining significance in linear regression (B = 2.903, p = 0.002), with the borderline logistic regression p-value (0.066) likely reflecting sample size. This resonates with evidence from Abate et al. [ 16 ] and a meta-analysis by Gonzalez-Bono et al. [ 17 ] showing negative correlation ( r = − 0.372) between social support and anxiety. Married individuals likely benefit from spousal support and shared decision-making [ 18 ], underscoring the importance of identifying socially isolated patients. Age was a significant bivariate predictor ( r = − 0.431, p 60 years; η²=0.206). Although non-significant in multivariate analysis (β=−0.194, p = 0.088)—likely due to collinearity with marital status—the bivariate association remains clinically meaningful. This corroborates Eberhart et al. [ 19 ] (n = 3,087) and the proposed mechanism of accumulated coping skills in older patients [ 20 , 21 ]. Surgery type showed the largest categorical effect (η²=0.298), with oncology patients exhibiting universal anxiety (100%, 16.83 ± 2.14) and highest information desire (8.67 ± 1.21), consistent with Tsimopoulou et al. [ 22 ] reporting 78% moderate-to-severe anxiety in cancer patients. General surgery patients showed markedly lower anxiety (9.72 ± 1.88), highlighting the need for specialized oncology psychological support [ 23 ]. Surgery-related anxiety exceeded anaesthesia-related anxiety (6.42 ± 1.88 vs 5.21 ± 1.81, d = 0.679), with 62% showing surgery-dominant patterns. Item 4 (concern about surgery) showed the strongest discrimination between groups ( d = 2.15). This is consistent with Eberhart et al. [ 19 ] and Celik and Edipoglu [ 24 ], suggesting patients primarily fear surgical outcomes rather than anaesthesia, informing counselling priorities. The anxiety–information correlation ( r = 0.594) and the finding that all high-information patients had high anxiety suggest information-seeking may represent an anxiety coping response. However, 16% showed high anxiety with low information desire, possibly indicating avoidant coping requiring distinct interventions. Information need was driven by clinical factors (surgery type, anaesthesia, prior experience) rather than demographics, suggesting informational interventions should be tailored to procedural context. Biological sex was non-significant (males 11.56 ± 3.39 vs females 11.72 ± 3.06, d = 0.05), contrasting with Celik and Edipoglu [ 24 ] and Bedaso et al. [ 3 ]. This may reflect South Asian cultural factors equalizing anxiety expression or our cohort composition where disease-related anxiety supersedes gender differences. Higher education was unexpectedly associated with greater anxiety (graduates 14.11 ± 4.20 vs illiterate 10.62 ± 3.38, p = 0.034), an "education paradox" diverging from conventional findings [ 3 , 10 ] but potentially attributable to greater health literacy, online information access, and higher expectations [ 25 ]. The APAIS showed good psychometric properties (α = 0.806), with all item-total correlations exceeding 0.30 and item deletion reducing alpha. This compares favourably with Turkish (α = 0.897) [ 13 ], German (α = 0.86) [ 14 ], Chinese (α = 0.84) [ 26 ], and Portuguese (α = 0.89) [ 27 ] validation studies, supporting cross-cultural applicability. Limitations include single-centre design, cross-sectional methodology precluding causal inference, sample size potentially limiting logistic regression power, and absence of postoperative outcome data. Strengths include comprehensive analysis with advanced statistical tests, systematic effect size reporting, sensitivity analysis confirming robustness, and novel Indian population data. Conclusion This study documented 48% prevalence of clinically significant preoperative anxiety in Western India. The APAIS demonstrated good psychometric properties (α = 0.806), supporting routine screening utility. Unmarried status was the strongest independent predictor (OR = 3.90, p = 0.002), followed by younger age, oncological procedures, and higher education. Surgery-related anxiety exceeded anaesthesia-related anxiety ( d = 0.68), suggesting counseling should prioritize surgical explanations. Sex, anaesthesia type, previous surgery, and family support were non-significant. Routine APAIS screening during preanaesthetic evaluation can identify high-risk patients, and risk-stratified interventions targeting unmarried patients, young adults, oncology patients, and highly educated individuals may optimize perioperative psychological outcomes. Declarations Ethics Approval and Consent to Participate This study received approval from the Sumandeep Vidyapeeth Institutional Ethics Committee (SVIEC/ON/MEDI/SRP/JUNE/23/92, approved 21 June 2023). Written informed consent was obtained from all participants. Consent for Publication: Not applicable. Availability of Data and Materials The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request. Competing Interests The authors have no competing interests to declare that are relevant to the content of this article. Funding The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. Authors' Contributions RT: Conceptualization, methodology, formal analysis, investigation, data curation, writing—original draft, project administration. AK: Validation, formal analysis, writing—review and editing. SMT: Conceptualization, methodology, supervision, writing—review and editing, final approval. All authors read and approved the final manuscript. Clinical Trial Number: Not Applicable Acknowledgements: Not applicable References Spielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1983. Bello CM, Eisler P, Heidegger T. Perioperative anxiety: current status and future perspectives. J Clin Med. 2025;14(5):1422. doi:10.3390/jcm14051422 Bedaso A, Mekonnen N, Duko B. 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Preoperative anxiety in adult patients undergoing day care surgery: prevalence and associated factors. Indian J Psychol Med. 2020;42(1):87–92. doi:10.4103/IJPSYM.IJPSYM_180_19 Moerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg. 1996;82(3):445–51. doi:10.1097/00000539-199603000-00002 Cetinkaya F, Kavuran E, Aslan KSU. Validity and reliability of the Amsterdam Preoperative Anxiety and Information Scale in the Turkish population. Turk J Med Sci. 2019;49(1):178–83. doi:10.3906/sag-1806-84 Berth H, Petrowski K, Balck F. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) – the first trial of a German version. GMS Psychosoc Med. 2007;4:Doc01. Lakhe G, Sharma A, Koirala S, Bhatta M, Poudel S. Preoperative anxiety and associated factors among patients undergoing surgery: a cross-sectional study. JNMA J Nepal Med Assoc. 2022;60(249):392–6. doi:10.31729/jnma.7408 Abate SM, Chekol YA, Basu B. Global prevalence and determinants of preoperative anxiety among surgical patients: a systematic review and meta-analysis. Int J Surg Open. 2020;25:6–16. doi:10.1016/j.ijso.2020.05.003 Gonzalez-Bono E, Campos-Bacas B, Tellez-Parra L. Social support and preoperative anxiety: a systematic review and meta-analysis. Health Psychol Rev. 2022;16(1):123–45. doi:10.1080/17437199.2021.1965547 Carr E, Brockbank K, Allen S, Strike P. Patterns and frequency of anxiety in women undergoing gynaecological surgery. J Clin Nurs. 2006;15(3):341–52. doi:10.1111/j.1365-2702.2006.01285.x Eberhart L, Aust H, Schuster M, Sturm T, Gehling M, Wulf H, et al. Preoperative anxiety in adults – a cross-sectional study on specific fears and risk factors. BMC Psychiatry. 2020;20(1):140. doi:10.1186/s12888-020-02552-w Williams JB, Alexander KP, Morin JF, Langlois Y, Noiseux N, Perrault LP, et al. Preoperative anxiety as a predictor of mortality and major morbidity in patients aged >70 years undergoing cardiac surgery. Am J Cardiol. 2013;111(1):137–42. doi:10.1016/j.amjcard.2012.08.060 Mitchell M. Patient anxiety and modern elective surgery: a literature review. J Clin Nurs. 2003;12(6):806–15. doi:10.1046/j.1365-2702.2003.00812.x Tsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Mirza DF, et al. Psychological prehabilitation before cancer surgery: a systematic review. Ann Surg Oncol. 2015;22(13):4117–23. doi:10.1245/s10434-015-4550-z Rosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg. 2006;14(7):397–405. doi:10.5435/00124635-200607000-00002 Celik F, Edipoglu IS. Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur J Med Res. 2018;23(1):41. doi:10.1186/s40001-018-0339-4 Kil HK, Kim WO, Chung WY, Kim GH, Seo H, Hong JY. Preoperative anxiety and pain sensitivity are independent predictors of propofol and sevoflurane requirements in general anaesthesia. Br J Anaesth. 2012;108(1):119–25. doi:10.1093/bja/aer305 Wu CL, Hsu WC, Tsai YT, Suen LJ, Tsai TH. The Chinese version of Amsterdam Preoperative Anxiety and Information Scale (APAIS): testing reliability and validity. Hu Li Za Zhi. 2014;61(3):58–67. doi:10.6224/JN.61.3.58 Braganca GM, Chaves Neto G, Oliveira Marques de Araujo A, Vasconcelos Lins-Kusterer LE, De Oliveira Barreto Suarez-Roa B, De Oliveira IR. Validation of the Brazilian Portuguese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Health Qual Life Outcomes. 2022;20(1):93. doi:10.1186/s12955-022-01995-z Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 06 May, 2026 Reviewers agreed at journal 30 Apr, 2026 Reviews received at journal 27 Apr, 2026 Reviewers agreed at journal 27 Apr, 2026 Reviewers agreed at journal 24 Apr, 2026 Reviewers invited by journal 21 Apr, 2026 Editor invited by journal 27 Mar, 2026 Editor assigned by journal 27 Mar, 2026 Submission checks completed at journal 27 Mar, 2026 First submitted to journal 26 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9236204","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631255577,"identity":"50b68166-4bd1-4f01-a84c-6e20fde22acf","order_by":0,"name":"Richa Tailor","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4klEQVRIie2PsQrCQAyGcwTOpepqadFXOBEUQemzSFe7OxYKdanOioNv4S4FX+IWp04OFZciN3i9KrjY1k3wviH5h3wJAdBofhEEqjptyJK+Qg2FAUUAsskVrL5TKNIFNIol5YyWmJwzEL0W4uk2uR9kAJJe558VO6ajfgSsHyJ1d96aywBobg+flQ4atGMAIyEaA/QiLoN8p1mhmAKYo5RxxJ1aiiWvzJQCGZ/VUOjQstnAzX8hK5/LQILyX9pxYl4W3el+GcSQCZ6HY3otUQrYs5NQVb9q/h3xzbBGo9H8Cw/+eTuSX7GGbQAAAABJRU5ErkJggg==","orcid":"","institution":"Sumandeep Vidyapeeth Deemed to be University","correspondingAuthor":true,"prefix":"","firstName":"Richa","middleName":"","lastName":"Tailor","suffix":""},{"id":631255578,"identity":"96301f95-63d8-4c25-ae21-e8c13bffeef9","order_by":1,"name":"Anupama Kumari","email":"","orcid":"","institution":"Sumandeep Vidyapeeth Deemed to be University","correspondingAuthor":false,"prefix":"","firstName":"Anupama","middleName":"","lastName":"Kumari","suffix":""},{"id":631255579,"identity":"9d6cf3ac-e976-4a64-9a99-f69f247bcdd2","order_by":2,"name":"Sara Mary Thomas","email":"","orcid":"","institution":"Sumandeep Vidyapeeth Deemed to be University","correspondingAuthor":false,"prefix":"","firstName":"Sara","middleName":"Mary","lastName":"Thomas","suffix":""}],"badges":[],"createdAt":"2026-03-26 15:53:48","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9236204/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9236204/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108388680,"identity":"e3bb6d5c-325c-4b74-bcbf-9b7273aad364","added_by":"auto","created_at":"2026-05-04 06:43:26","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":656084,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAPAIS Psychometric Properties and Score Distribution. \u003c/strong\u003e(A) Distribution of APAIS anxiety, information, and total scores. (B) Corrected item-total correlations with Cronbach’s alpha. (C) Inter-item correlation heatmap. (D) APAIS item profiles by anxiety category.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9236204/v1/0ebc7a2f085da90a695c7bde.jpeg"},{"id":108492362,"identity":"7ef39d54-6156-4fe4-861f-a8a94be562bb","added_by":"auto","created_at":"2026-05-05 09:57:35","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":301865,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBivariate Associations and Anxiety Predictors. \u003c/strong\u003e(A) Paired comparison of surgery versus anaesthesia anxiety. (B) Anxiety dominance scatter plot. (C) APAIS anxiety scores by type of surgery. (D) APAIS anxiety scores by demographic variables.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9236204/v1/df8e011db62722a51a08213f.jpeg"},{"id":108388682,"identity":"e23263f2-f92b-4801-8e26-3dab6d7144fe","added_by":"auto","created_at":"2026-05-04 06:43:26","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":244358,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eMultivariate Analysis and Summary. \u003c/strong\u003e(A) Anxiety–information subscale correlation. (B) Anxiety–information discordance profiles. (C) Multiple linear regression coefficients. (D) Binary logistic regression odds ratios.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9236204/v1/41dcbc9f19e6ab00f4be5b45.jpeg"},{"id":108493391,"identity":"5556126b-deb1-4fa8-8ab2-8821968553e5","added_by":"auto","created_at":"2026-05-05 10:00:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1613000,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9236204/v1/3c69c41c-13da-4fcf-8e63-fe02e97ceb12.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Marital Status Supersedes Sex as the Primary Predictor of Preoperative Anxiety Among Elective Surgery Patients in Western India: A Cross-Sectional APAIS Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePreoperative anxiety, defined as apprehension and heightened autonomic arousal regarding impending surgery and anaesthesia, represents an underrecognized perioperative stressor with profound implications for patient outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Globally, 60\u0026ndash;80% of surgical patients experience some degree of preoperative anxiety, with approximately half of patients in low- and middle-income countries meeting criteria for clinically significant anxiety [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe clinical significance extends beyond psychological distress. Anxiety-induced hypothalamic-pituitary-adrenal axis activation suppresses immune function, reduces neutrophil migration, and diminishes cytokine production, impairing wound healing and increasing infection susceptibility [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Anxious patients are four times more likely to experience delayed healing [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Preoperative anxiety also increases anaesthetic requirements, with highly anxious patients requiring 15\u0026ndash;20% higher propofol doses (2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 vs 1.8\u0026thinsp;\u0026plusmn;\u0026thinsp;0.3 mg/kg) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Meta-analytic evidence confirms increased analgesic requirements (SMD\u0026thinsp;=\u0026thinsp;1.02, 95% CI: 0.29\u0026ndash;1.76), prolonged recovery times, and independently predicted postoperative delirium (OR\u0026thinsp;=\u0026thinsp;2.03, 95% CI: 1.49\u0026ndash;2.76) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMultiple factors contribute to preoperative anxiety. A systematic review of 27 studies from low- and middle-income countries identified female gender, younger age, lower education, inadequate information, and fear of death as significant predictors [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Oncological and gynaecological procedures are consistently associated with elevated anxiety [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Female sex has emerged as an independent predictor, with women demonstrating higher APAIS anxiety scores (12.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9 vs 9.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.0, p\u0026thinsp;=\u0026thinsp;0.003) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Indian data from Jiwanmall et al. reported 58.1% prevalence among day care surgery patients [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe APAIS, developed by Moerman et al. in 1996, uniquely differentiates between anxiety and information desire through six items on a 5-point Likert scale [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The anxiety subscale correlates highly with the State-Trait Anxiety Inventory (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.74) and completes within two minutes. Validation studies across Turkish (α\u0026thinsp;=\u0026thinsp;0.897), German, Japanese, and Chinese populations confirm robust reliability and consistent two-factor structure [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The established cutoff of APAIS anxiety subscale\u0026thinsp;\u0026gt;\u0026thinsp;11 identifies approximately 32% of patients as requiring intervention [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite substantial international literature, data from Indian populations remain limited. Cultural factors influencing emotional expression and family support structures may modulate anxiety responses differently in South Asian contexts. This study aimed to determine preoperative anxiety prevalence, evaluate APAIS psychometric properties, and identify predictors to inform targeted interventions at a tertiary care hospital in Western India.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Setting\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study was conducted at the Department of Anaesthesiology, Dhiraj Hospital, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, India\u0026mdash;a 1000-bed tertiary care teaching hospital. Patients were recruited over 12 months (July 2023\u0026ndash;June 2024) from general surgery, orthopaedics, otorhinolaryngology, gynaecology, urology, oncology, and neurosurgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethics approval (SVIEC/ON/MEDI/SRP/JUNE/23/92, approved 21 June 2023), was conducted per the Declaration of Helsinki and Good Clinical Practice guidelines, and obtained written informed consent from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size Calculation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing n=Z\u0026sup2;pq/d\u0026sup2; with Z=1.96, p=0.48 (based on Bedaso et al. [3]), q=0.52, and d=0.10: n=(1.96)\u0026sup2;\u0026times;0.48\u0026times;0.52/(0.10)\u0026sup2;=95.8, rounded to 96. Accounting for dropouts, the target was 100 participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant Selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInclusion criteria: age \u0026ge;18 years; elective surgery under general or regional anaesthesia; ASA I\u0026ndash;III; ability to respond in Hindi, Gujarati, or English; written informed consent. Exclusion criteria: emergency procedures; psychiatric disorders or psychotropic medication; cognitive impairment; previous adverse anaesthetic events requiring psychological intervention; consent refusal. Every third eligible patient at preanaesthetic evaluation was approached using systematic random sampling.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Instrument\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured questionnaire was administered via face-to-face interviews one day before surgery. Section A captured demographics and clinical variables: age, sex, marital status, education, surgery type, anaesthesia type, previous surgical/anaesthetic history, and family support. Section B comprised the APAIS: Items 1 and 2 assess anaesthesia-related anxiety, Items 4 and 5 assess surgery-related anxiety, and Items 3 and 6 evaluate information desire. The anxiety subscale (Items 1,2,4,5; range 4\u0026ndash;20) and information subscale (Items 3,6; range 2\u0026ndash;10) were calculated, with clinically significant anxiety defined as APAIS-A \u0026gt;11.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnalysis used R version 4.5.2. Normality was assessed using Shapiro-Wilk test; reliability using Cronbach alpha (\u0026ge;0.70 acceptable). Bivariate analyses included independent t-tests (with Welch correction), one-way ANOVA with Tukey HSD post-hoc, chi-square/Fisher exact tests, and Pearson correlations. Effect sizes used Cohen \u003cem\u003ed\u003c/em\u003e (small 0.2\u0026ndash;0.5, medium 0.5\u0026ndash;0.8, large \u0026gt;0.8) and eta-squared (small 0.01\u0026ndash;0.06, medium 0.06\u0026ndash;0.14, large \u0026gt;0.14). Multivariate analyses included multiple linear regression and binary logistic regression with VIF for multicollinearity (\u0026lt;5 acceptable). Two-tailed p\u0026lt;0.05 was considered significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eParticipant Characteristics and Anxiety Prevalence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf 108 patients screened, 100 completed the protocol (response rate 92.6%). Table 1 presents demographics and subgroup anxiety prevalence. The sample comprised 57 males and 43 females (mean age 43.97\u0026plusmn;17.63 years; range 18\u0026ndash;80). Most were married (77%) with primary education or below (59%). General surgery was most common (25%), followed by orthopaedics (22%) and ENT (21%). Regional anaesthesia was planned for 68%, and 91% had family support.\u003c/p\u003e\n\u003cp\u003eOverall anxiety prevalence was 48% (n=48, 95% CI: 38.1\u0026ndash;57.9%) . As shown in Table 1, highest rates were observed among single patients (82.6%), those aged 18\u0026ndash;30 (70.0%), oncology patients (100%), and higher secondary educated (85.7%). High-anxiety patients were younger (37.50\u0026plusmn;16.88 vs 49.94\u0026plusmn;16.28 years).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Baseline Demographics and Anxiety Prevalence by Subgroup (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHigh Anxiety n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e57 (57.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e27 (47.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e43 (43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e21 (48.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e18\u0026ndash;30 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e30 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e21 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e31\u0026ndash;45 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e24 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e15 (62.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e46\u0026ndash;60 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e6 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003e\u0026gt;60 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e21 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e6 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e29 (29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e11 (37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e30 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e14 (46.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e11 (44.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eHigher Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e7 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e6 (85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e9 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e6 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e77 (77.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e29 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e23 (23.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e19 (82.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eGeneral Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e25 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e5 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eOrthopaedics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e22 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e11 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e21 (21.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e11 (52.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eGynaecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e16 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e12 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eUrology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e8 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e3 (37.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eOncology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e6 (6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e6 (100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNeurosurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e2 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e0 (0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnaesthesia Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eRegional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e68 (68.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e31 (45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e32 (32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e17 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e82 (82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e39 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e18 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e9 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious Anaesthesia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e82 (82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e39 (47.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e18 (18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e9 (50.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e91 (91.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e42 (46.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 31px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 25px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13px;\"\u003e\n \u003cp\u003e9 (9.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 29px;\"\u003e\n \u003cp\u003e6 (66.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAPAIS Score Distribution and Psychometric Properties\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMean total APAIS was 16.93\u0026plusmn;4.36 (median 16.5, range 8\u0026ndash;30). Anxiety subscale mean was 11.63\u0026plusmn;3.23 (median 11, skewness +0.36, kurtosis \u0026minus;0.69) and information subscale mean was 5.29\u0026plusmn;1.57 (median 5, skewness +0.52, kurtosis +0.26). Shapiro-Wilk testing indicated non-normal distributions for anxiety (W=0.962, p=0.006) and information (W=0.933, p\u0026lt;0.001) subscales, with borderline normality for the total score (W=0.976, p=0.059).\u003c/p\u003e\n\u003cp\u003eSurgery-related items scored highest: Item 4 (concern about surgery: 3.32\u0026plusmn;1.09), Item 5 (thoughts about surgery: 3.10\u0026plusmn;1.06), Item 6 (information about surgery: 2.73\u0026plusmn;1.00), Item 1 (concern about anaesthesia: 2.68\u0026plusmn;1.12), Item 3 (information about anaesthesia: 2.57\u0026plusmn;0.87), and Item 2 (thoughts about anaesthesia: 2.53\u0026plusmn;0.94). All items were significantly higher in the high-anxiety group (all p\u0026lt;0.001), with Item 4 showing the largest discrimination (high 4.15\u0026plusmn;0.50 vs low 2.56\u0026plusmn;0.92; \u003cem\u003ed\u003c/em\u003e=2.15).\u003c/p\u003e\n\u003cp\u003eCronbach alpha was 0.806 (full scale), 0.767 (anxiety subscale), and 0.578 (information subscale). All item-total correlations exceeded 0.30 (range 0.485\u0026ndash;0.662), and deleting any item reduced alpha. Item 4 had the highest item-total correlation (\u003cem\u003er\u003c/em\u003e=0.662). All 15 inter-item correlations were significant (strongest: Items 5\u0026ndash;6, \u003cem\u003er\u003c/em\u003e=0.577; weakest: Items 1\u0026ndash;6, \u003cem\u003er\u003c/em\u003e=0.210). Subscale correlations showed moderate anxiety\u0026ndash;information association (\u003cem\u003er\u003c/em\u003e=0.584, p\u0026lt;0.001), with strong subscale\u0026ndash;total correlations (anxiety\u0026ndash;total \u003cem\u003er\u003c/em\u003e=0.956; information\u0026ndash;total \u003cem\u003er\u003c/em\u003e=0.797) (Figure 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBivariate Associations with Preoperative Anxiety\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 presents bivariate associations. Chi-square/Fisher exact tests showed significant associations with age group (\u0026chi;\u0026sup2;=16.784, df=3, p\u0026lt;0.001), marital status (\u0026chi;\u0026sup2;=14.334, df=1, p\u0026lt;0.001), and surgery type (Fisher p=0.001). Sex, education, anaesthesia type, previous surgery/anaesthesia, and family support were non-significant.\u003c/p\u003e\n\u003cp\u003eSingle patients had markedly higher anxiety than married patients, representing the study\u0026apos;s largest effect. Younger patients (18\u0026ndash;50) scored higher than those \u0026gt;50 with medium effect. Family support showed significance on equal-variance t-test (p=0.027) but not Welch-corrected test (p=0.112), which was preferred given group imbalance (n=9 vs 91). Sex, anaesthesia type, and previous surgery showed no differences.\u003c/p\u003e\n\u003cp\u003eANOVA revealed significant differences across surgical specialties (\u0026eta;\u0026sup2;=0.298, large). Tukey post-hoc showed oncology patients scored significantly higher than all other groups (differences +4.15 to +7.33, all p\u0026lt;0.05), and gynaecology exceeded general surgery (p=0.021). Age groups differed significantly (\u0026eta;\u0026sup2;=0.206, large), with 18\u0026ndash;30 year olds higher than 46\u0026ndash;60 (p\u0026lt;0.001) and \u0026gt;60 (p\u0026lt;0.001). Education showed medium effect (\u0026eta;\u0026sup2;=0.105), with graduates higher than illiterate patients (p=0.034).\u003c/p\u003e\n\u003cp\u003eAge correlated negatively with anxiety (\u003cem\u003er\u003c/em\u003e=\u0026minus;0.431, p\u0026lt;0.001; Spearman \u0026rho;=\u0026minus;0.436). Point-biserial correlations confirmed associations with single status (\u003cem\u003er\u003c/em\u003e=+0.491, p\u0026lt;0.001) and younger age (\u003cem\u003er\u003c/em\u003e=+0.296, p=0.003), but not sex (\u003cem\u003er\u003c/em\u003e=+0.025, p=0.808) or previous surgery (\u003cem\u003er\u003c/em\u003e=+0.062, p=0.540).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Bivariate Associations Between Variables and APAIS Anxiety Scores (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStatistic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect Size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.56\u0026plusmn;3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003et=\u0026minus;0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003ed\u003c/em\u003e=0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.72\u0026plusmn;3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eChi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group (2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e18\u0026ndash;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e12.34\u0026plusmn;3.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003et=3.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003ed\u003c/em\u003e=0.64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026gt;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e10.36\u0026plusmn;2.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eChi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=6.858\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Group (4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e18\u0026ndash;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e13.63\u0026plusmn;3.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eANOVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eF(3,96)=8.298\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026eta;\u0026sup2;=0.206\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e31\u0026ndash;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.79\u0026plusmn;2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e46\u0026ndash;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e10.48\u0026plusmn;2.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026gt;60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e9.95\u0026plusmn;3.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e14.52\u0026plusmn;3.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003et=\u0026minus;5.582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003ed\u003c/em\u003e=1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e10.77\u0026plusmn;2.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eChi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=14.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e10.62\u0026plusmn;3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eANOVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eF(4,95)=2.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026eta;\u0026sup2;=0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.47\u0026plusmn;3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.60\u0026plusmn;2.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eHigher Secondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e13.43\u0026plusmn;2.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eGraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e14.11\u0026plusmn;4.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eGeneral Surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e9.72\u0026plusmn;1.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eANOVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eF(6,93)=6.586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026eta;\u0026sup2;=0.298\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eNeurosurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e9.50\u0026plusmn;2.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eUrology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e10.00\u0026plusmn;3.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.95\u0026plusmn;2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eOrthopaedics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e12.09\u0026plusmn;3.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eGynaecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e12.69\u0026plusmn;2.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eFisher exact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eOncology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e16.83\u0026plusmn;2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnaesthesia Type\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eGeneral\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e12.38\u0026plusmn;3.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003et=1.593\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003ed\u003c/em\u003e=0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eRegional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.28\u0026plusmn;3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eChi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.482\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e12.06\u0026plusmn;3.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003et-test\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003et=\u0026minus;0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003ed\u003c/em\u003e=0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.54\u0026plusmn;3.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eChi-square\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026chi;\u0026sup2;=0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e13.89\u0026plusmn;4.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eWelch t\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003et=1.765\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cem\u003ed\u003c/em\u003e=0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 3px;\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e11.41\u0026plusmn;3.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eFisher exact\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eSurgery versus Anaesthesia Anxiety Components\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSurgery-related anxiety (Items 4+5: 6.42\u0026plusmn;1.88) significantly exceeded anaesthesia-related anxiety (Items 1+2: 5.21\u0026plusmn;1.81). Both paired t-test (t(99)=6.788, p\u0026lt;0.001, \u003cem\u003ed\u003c/em\u003e=0.679) and Wilcoxon signed-rank test (V=2548, p\u0026lt;0.001) confirmed this difference, as paired differences were non-normal (Shapiro-Wilk W=0.954, p=0.002). The mean difference was 1.21\u0026plusmn;1.78 (range \u0026minus;4 to +6). Anxiety dominance classification showed 62% surgery-dominant (n=62), 24% equal (n=24), and 14% anaesthesia-dominant (n=14) (Figure 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAnxiety\u0026ndash;Information Relationship and Discordance Profiles\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnxiety and information subscales were moderately correlated (\u003cem\u003er\u003c/em\u003e=0.594, p\u0026lt;0.001, R\u0026sup2;=0.352), holding within both high-anxiety (\u003cem\u003er\u003c/em\u003e=0.432, p=0.002) and low-anxiety (\u003cem\u003er\u003c/em\u003e=0.366, p=0.008) subgroups. All 8 patients with high information need (score \u0026ge;8) had high anxiety; no low-anxiety patient showed high information need. Median-split discordance profiles revealed: high anxiety/high information (32%), low anxiety/low information (36%), high anxiety/low information (16%), and low anxiety/high information (16%). The 16% with high anxiety but low information desire represent a subgroup requiring different intervention approaches.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformation Subscale Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMean information score was 5.29\u0026plusmn;1.57; only 8% had high information need. Information scores were driven by clinical factors: surgery type (F(6,93)=15.011, p\u0026lt;0.001; oncology 8.67\u0026plusmn;1.21, general surgery 3.92\u0026plusmn;0.81), anxiety category (high 6.06\u0026plusmn;1.56 vs low 4.58\u0026plusmn;1.21; p\u0026lt;0.001), previous surgery (yes 6.22\u0026plusmn;2.10 vs no 5.09\u0026plusmn;1.36; p=0.040), and anaesthesia type (general 5.81\u0026plusmn;1.73 vs regional 5.04\u0026plusmn;1.44; p=0.034). Age (\u003cem\u003er\u003c/em\u003e=\u0026minus;0.078, p=0.442), education (F(4,95)=2.102, p=0.087), sex, marital status, and family support were non-significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultivariate Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presents regression results. Linear regression yielded R\u0026sup2;=0.318, adjusted R\u0026sup2;=0.282, F(5,94)=8.786, p\u0026lt;0.001. Only marital status was independently significant; age, sex, and family support showed non-significant trends. All VIFs were \u0026lt;2. Logistic regression showed overall significance (LR \u0026chi;\u0026sup2;=18.084, df=4, p=0.001; McFadden R\u0026sup2;=0.131; AIC=130.39), with single patients having nearly four-fold higher odds (OR=3.90), though borderline Wald significance (p=0.066) likely reflects sample size. Classification accuracy was 68.0% (sensitivity 47.9%, specificity 86.5%) (Figure 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Multivariate Regression Analyses (n=100)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredictor\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLinear Regression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLogistic Regression\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026beta;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(Intercept)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e11.762\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e1.132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e10.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.418\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026minus;0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026minus;0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026minus;1.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026minus;0.025\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.975\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.945\u0026ndash;1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex (Female)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.092\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.592\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e\u0026mdash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status (Single)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2.903\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.915\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e3.174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e3.896\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.915\u0026ndash;16.584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.066\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnaesthesia (General)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e0.687\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1.136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.433\u0026ndash;2.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Support (No)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.761\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003e1.802\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.492\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e1.636\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.327\u0026ndash;8.180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel Fit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eR\u0026sup2;=0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9px;\"\u003e\n \u003cp\u003eAdj R\u0026sup2;=0.282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 14px;\"\u003e\n \u003cp\u003eF(5,94)=8.786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12px;\"\u003e\n \u003cp\u003eLR \u0026chi;\u0026sup2;=18.084\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003edf=4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003eMcFadden R\u0026sup2;=0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 6px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eLinear regression: B=unstandardized coefficient, \u0026beta;=standardized coefficient. Logistic regression: OR=odds ratio. All VIFs \u0026lt;2.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSensitivity Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eExcluding three data-entry discrepancy cases (n=97) confirmed robustness: prevalence remained 48.5%, all associations retained direction and significance, linear R\u0026sup2; improved to 0.362, and marital status significance strengthened (p\u0026lt;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study revealed 48% prevalence of clinically significant preoperative anxiety among elective surgery patients in Western India, aligning with global estimates from Bedaso et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] who reported 55.7% pooled prevalence across 27 low- and middle-income country studies. Our prevalence exceeds that of Lakhe et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] in Nepal (22.85%), likely reflecting methodological differences, but is lower than the 58.1% reported by Jiwanmall et al. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] among Indian day care patients, possibly due to differences in surgical complexity.\u003c/p\u003e \u003cp\u003eUnmarried status emerged as the strongest independent predictor (14.52\u0026thinsp;\u0026plusmn;\u0026thinsp;3.12 vs 10.77\u0026thinsp;\u0026plusmn;\u0026thinsp;2.74, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.33; OR\u0026thinsp;=\u0026thinsp;3.90, 95% CI: 0.92\u0026ndash;16.58). Marital status was the only variable retaining significance in linear regression (B\u0026thinsp;=\u0026thinsp;2.903, p\u0026thinsp;=\u0026thinsp;0.002), with the borderline logistic regression p-value (0.066) likely reflecting sample size. This resonates with evidence from Abate et al. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and a meta-analysis by Gonzalez-Bono et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] showing negative correlation (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.372) between social support and anxiety. Married individuals likely benefit from spousal support and shared decision-making [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], underscoring the importance of identifying socially isolated patients.\u003c/p\u003e \u003cp\u003eAge was a significant bivariate predictor (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.431, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with 18\u0026ndash;30 year olds scoring highest (13.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.21 vs 9.95\u0026thinsp;\u0026plusmn;\u0026thinsp;3.04 in \u0026gt;\u0026thinsp;60 years; η\u0026sup2;=0.206). Although non-significant in multivariate analysis (β=\u0026minus;0.194, p\u0026thinsp;=\u0026thinsp;0.088)\u0026mdash;likely due to collinearity with marital status\u0026mdash;the bivariate association remains clinically meaningful. This corroborates Eberhart et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] (n\u0026thinsp;=\u0026thinsp;3,087) and the proposed mechanism of accumulated coping skills in older patients [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgery type showed the largest categorical effect (η\u0026sup2;=0.298), with oncology patients exhibiting universal anxiety (100%, 16.83\u0026thinsp;\u0026plusmn;\u0026thinsp;2.14) and highest information desire (8.67\u0026thinsp;\u0026plusmn;\u0026thinsp;1.21), consistent with Tsimopoulou et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] reporting 78% moderate-to-severe anxiety in cancer patients. General surgery patients showed markedly lower anxiety (9.72\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88), highlighting the need for specialized oncology psychological support [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSurgery-related anxiety exceeded anaesthesia-related anxiety (6.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 vs 5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.679), with 62% showing surgery-dominant patterns. Item 4 (concern about surgery) showed the strongest discrimination between groups (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.15). This is consistent with Eberhart et al. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] and Celik and Edipoglu [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], suggesting patients primarily fear surgical outcomes rather than anaesthesia, informing counselling priorities.\u003c/p\u003e \u003cp\u003eThe anxiety\u0026ndash;information correlation (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.594) and the finding that all high-information patients had high anxiety suggest information-seeking may represent an anxiety coping response. However, 16% showed high anxiety with low information desire, possibly indicating avoidant coping requiring distinct interventions. Information need was driven by clinical factors (surgery type, anaesthesia, prior experience) rather than demographics, suggesting informational interventions should be tailored to procedural context.\u003c/p\u003e \u003cp\u003eBiological sex was non-significant (males 11.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39 vs females 11.72\u0026thinsp;\u0026plusmn;\u0026thinsp;3.06, \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05), contrasting with Celik and Edipoglu [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and Bedaso et al. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This may reflect South Asian cultural factors equalizing anxiety expression or our cohort composition where disease-related anxiety supersedes gender differences.\u003c/p\u003e \u003cp\u003eHigher education was unexpectedly associated with greater anxiety (graduates 14.11\u0026thinsp;\u0026plusmn;\u0026thinsp;4.20 vs illiterate 10.62\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38, p\u0026thinsp;=\u0026thinsp;0.034), an \"education paradox\" diverging from conventional findings [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] but potentially attributable to greater health literacy, online information access, and higher expectations [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe APAIS showed good psychometric properties (α\u0026thinsp;=\u0026thinsp;0.806), with all item-total correlations exceeding 0.30 and item deletion reducing alpha. This compares favourably with Turkish (α\u0026thinsp;=\u0026thinsp;0.897) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], German (α\u0026thinsp;=\u0026thinsp;0.86) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], Chinese (α\u0026thinsp;=\u0026thinsp;0.84) [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], and Portuguese (α\u0026thinsp;=\u0026thinsp;0.89) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] validation studies, supporting cross-cultural applicability.\u003c/p\u003e \u003cp\u003eLimitations include single-centre design, cross-sectional methodology precluding causal inference, sample size potentially limiting logistic regression power, and absence of postoperative outcome data. Strengths include comprehensive analysis with advanced statistical tests, systematic effect size reporting, sensitivity analysis confirming robustness, and novel Indian population data.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study documented 48% prevalence of clinically significant preoperative anxiety in Western India. The APAIS demonstrated good psychometric properties (α\u0026thinsp;=\u0026thinsp;0.806), supporting routine screening utility. Unmarried status was the strongest independent predictor (OR\u0026thinsp;=\u0026thinsp;3.90, p\u0026thinsp;=\u0026thinsp;0.002), followed by younger age, oncological procedures, and higher education. Surgery-related anxiety exceeded anaesthesia-related anxiety (\u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.68), suggesting counseling should prioritize surgical explanations. Sex, anaesthesia type, previous surgery, and family support were non-significant. Routine APAIS screening during preanaesthetic evaluation can identify high-risk patients, and risk-stratified interventions targeting unmarried patients, young adults, oncology patients, and highly educated individuals may optimize perioperative psychological outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received approval from the Sumandeep Vidyapeeth Institutional Ethics Committee (SVIEC/ON/MEDI/SRP/JUNE/23/92, approved 21 June 2023). Written informed consent was obtained from all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRT: Conceptualization, methodology, formal analysis, investigation, data curation, writing\u0026mdash;original draft, project administration. AK: Validation, formal analysis, writing\u0026mdash;review and editing. SMT: Conceptualization, methodology, supervision, writing\u0026mdash;review and editing, final approval. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eNot applicable\u003c/p\u003e"},{"header":"References","content":"\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eSpielberger CD, Gorsuch RL, Lushene R, Vagg PR, Jacobs GA. Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press; 1983.\u003c/li\u003e\n \u003cli\u003eBello CM, Eisler P, Heidegger T. Perioperative anxiety: current status and future perspectives. J Clin Med. 2025;14(5):1422. doi:10.3390/jcm14051422\u003c/li\u003e\n \u003cli\u003eBedaso A, Mekonnen N, Duko B. 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. 2022;12(3):e058187. doi:10.1136/bmjopen-2021-058187\u003c/li\u003e\n \u003cli\u003eCaumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, et al. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand. 2001;45(3):298\u0026ndash;307. doi:10.1034/j.1399-6576.2001.045003298.x\u003c/li\u003e\n \u003cli\u003eGouin JP, Kiecolt-Glaser JK. The impact of psychological stress on wound healing: methods and mechanisms. Immunol Allergy Clin North Am. 2011;31(1):81\u0026ndash;93. doi:10.1016/j.iac.2010.09.010\u003c/li\u003e\n \u003cli\u003eBroadbent E, Petrie KJ, Alley PG, Booth RJ. Psychological stress impairs early wound repair following surgery. Psychosom Med. 2003;65(5):865\u0026ndash;9. doi:10.1097/01.psy.0000088589.92699.30\u003c/li\u003e\n \u003cli\u003eMaranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg. 1999;89(6):1346\u0026ndash;51. doi:10.1097/00000539-199912000-00003\u003c/li\u003e\n \u003cli\u003eShebl MA, Toraih E, Shebl M, Elsherbini DM, Elsherbiny NM, Schaalan MF, et al. Preoperative anxiety and its impact on surgical outcomes: a systematic review and meta-analysis. J Clin Transl Sci. 2025;9(1):e33. doi:10.1017/cts.2025.6\u003c/li\u003e\n \u003cli\u003eOh J, Lee W, Ki S, Suh J, Hwang S, Lee J. Assessment of preoperative anxiety and influencing factors in patients undergoing elective surgery: an observational cross-sectional study. Medicina (Kaunas). 2024;60(3):403. doi:10.3390/medicina60030403\u003c/li\u003e\n \u003cli\u003eMavridou P, Dimitriou V, Manataki A, Arnaoutoglou E, Papadopoulos G. Patient\u0026apos;s anxiety and fear of anesthesia: effect of gender, age, education, and previous experience of anesthesia. A survey of 400 patients. J Anesth. 2013;27(1):104\u0026ndash;8. doi:10.1007/s00540-012-1460-0\u003c/li\u003e\n \u003cli\u003eJiwanmall M, Jiwanmall SA, Williams A, Kamakshi S, Sugirtharaj L, Poornima K, et al. Preoperative anxiety in adult patients undergoing day care surgery: prevalence and associated factors. Indian J Psychol Med. 2020;42(1):87\u0026ndash;92. doi:10.4103/IJPSYM.IJPSYM_180_19\u003c/li\u003e\n \u003cli\u003eMoerman N, van Dam FS, Muller MJ, Oosting H. The Amsterdam Preoperative Anxiety and Information Scale (APAIS). Anesth Analg. 1996;82(3):445\u0026ndash;51. doi:10.1097/00000539-199603000-00002\u003c/li\u003e\n \u003cli\u003eCetinkaya F, Kavuran E, Aslan KSU. Validity and reliability of the Amsterdam Preoperative Anxiety and Information Scale in the Turkish population. Turk J Med Sci. 2019;49(1):178\u0026ndash;83. doi:10.3906/sag-1806-84\u003c/li\u003e\n \u003cli\u003eBerth H, Petrowski K, Balck F. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) \u0026ndash; the first trial of a German version. GMS Psychosoc Med. 2007;4:Doc01.\u003c/li\u003e\n \u003cli\u003eLakhe G, Sharma A, Koirala S, Bhatta M, Poudel S. Preoperative anxiety and associated factors among patients undergoing surgery: a cross-sectional study. JNMA J Nepal Med Assoc. 2022;60(249):392\u0026ndash;6. doi:10.31729/jnma.7408\u003c/li\u003e\n \u003cli\u003eAbate SM, Chekol YA, Basu B. Global prevalence and determinants of preoperative anxiety among surgical patients: a systematic review and meta-analysis. Int J Surg Open. 2020;25:6\u0026ndash;16. doi:10.1016/j.ijso.2020.05.003\u003c/li\u003e\n \u003cli\u003eGonzalez-Bono E, Campos-Bacas B, Tellez-Parra L. Social support and preoperative anxiety: a systematic review and meta-analysis. Health Psychol Rev. 2022;16(1):123\u0026ndash;45. doi:10.1080/17437199.2021.1965547\u003c/li\u003e\n \u003cli\u003eCarr E, Brockbank K, Allen S, Strike P. Patterns and frequency of anxiety in women undergoing gynaecological surgery. J Clin Nurs. 2006;15(3):341\u0026ndash;52. doi:10.1111/j.1365-2702.2006.01285.x\u003c/li\u003e\n \u003cli\u003eEberhart L, Aust H, Schuster M, Sturm T, Gehling M, Wulf H, et al. Preoperative anxiety in adults \u0026ndash; a cross-sectional study on specific fears and risk factors. BMC Psychiatry. 2020;20(1):140. doi:10.1186/s12888-020-02552-w\u003c/li\u003e\n \u003cli\u003eWilliams JB, Alexander KP, Morin JF, Langlois Y, Noiseux N, Perrault LP, et al. Preoperative anxiety as a predictor of mortality and major morbidity in patients aged \u0026gt;70 years undergoing cardiac surgery. Am J Cardiol. 2013;111(1):137\u0026ndash;42. doi:10.1016/j.amjcard.2012.08.060\u003c/li\u003e\n \u003cli\u003eMitchell M. Patient anxiety and modern elective surgery: a literature review. J Clin Nurs. 2003;12(6):806\u0026ndash;15. doi:10.1046/j.1365-2702.2003.00812.x\u003c/li\u003e\n \u003cli\u003eTsimopoulou I, Pasquali S, Howard R, Desai A, Gourevitch D, Mirza DF, et al. Psychological prehabilitation before cancer surgery: a systematic review. Ann Surg Oncol. 2015;22(13):4117\u0026ndash;23. doi:10.1245/s10434-015-4550-z\u003c/li\u003e\n \u003cli\u003eRosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg. 2006;14(7):397\u0026ndash;405. doi:10.5435/00124635-200607000-00002\u003c/li\u003e\n \u003cli\u003eCelik F, Edipoglu IS. Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur J Med Res. 2018;23(1):41. doi:10.1186/s40001-018-0339-4\u003c/li\u003e\n \u003cli\u003eKil HK, Kim WO, Chung WY, Kim GH, Seo H, Hong JY. Preoperative anxiety and pain sensitivity are independent predictors of propofol and sevoflurane requirements in general anaesthesia. Br J Anaesth. 2012;108(1):119\u0026ndash;25. doi:10.1093/bja/aer305\u003c/li\u003e\n \u003cli\u003eWu CL, Hsu WC, Tsai YT, Suen LJ, Tsai TH. The Chinese version of Amsterdam Preoperative Anxiety and Information Scale (APAIS): testing reliability and validity. Hu Li Za Zhi. 2014;61(3):58\u0026ndash;67. doi:10.6224/JN.61.3.58\u003c/li\u003e\n \u003cli\u003eBraganca GM, Chaves Neto G, Oliveira Marques de Araujo A, Vasconcelos Lins-Kusterer LE, De Oliveira Barreto Suarez-Roa B, De Oliveira IR. Validation of the Brazilian Portuguese version of the Amsterdam Preoperative Anxiety and Information Scale (APAIS). Health Qual Life Outcomes. 2022;20(1):93. doi:10.1186/s12955-022-01995-z\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Preoperative anxiety, Amsterdam Preoperative Anxiety and Information Scale, Elective surgery, Anaesthesia, Psychological stress, Perioperative care","lastPublishedDoi":"10.21203/rs.3.rs-9236204/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9236204/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003ePreoperative anxiety significantly impacts perioperative outcomes through neuroendocrine activation, increased anaesthetic requirements, and impaired recovery. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) provides a validated, rapid tool for identifying high-risk patients. This study aimed to determine preoperative anxiety prevalence and identify associated demographic and clinical predictors among adult patients scheduled for elective surgery using the APAIS.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e This cross-sectional study was conducted at a tertiary care hospital in Western India (July 2023\u0026ndash;June 2024). One hundred adults scheduled for elective surgery were recruited through systematic random sampling. The six-item APAIS was administered, with clinically significant anxiety defined as anxiety subscale score\u0026thinsp;\u0026gt;\u0026thinsp;11. Analysis included descriptive statistics, t-tests, ANOVA, chi-square tests, correlations, and multiple regression using R version 4.5.2.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eClinically significant anxiety prevalence was 48% (95% CI: 38.1\u0026ndash;57.9%). Mean APAIS scores were: anxiety 11.63\u0026thinsp;\u0026plusmn;\u0026thinsp;3.23, information 5.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.57, total 16.93\u0026thinsp;\u0026plusmn;\u0026thinsp;4.36. The APAIS showed good internal consistency (Cronbach α\u0026thinsp;=\u0026thinsp;0.806). Significant predictors included unmarried status (Cohen \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.33, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), younger age (\u003cem\u003er\u003c/em\u003e\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.43, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), oncological procedures (η\u0026sup2;=0.30, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and higher education (η\u0026sup2;=0.11, p\u0026thinsp;=\u0026thinsp;0.031). Surgery-related anxiety exceeded anaesthesia-related anxiety (6.42\u0026thinsp;\u0026plusmn;\u0026thinsp;1.88 vs 5.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.81; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.68). Only marital status remained independently significant in multivariate analysis (B\u0026thinsp;=\u0026thinsp;2.90, p\u0026thinsp;=\u0026thinsp;0.002; OR\u0026thinsp;=\u0026thinsp;3.90).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eNearly half of elective surgery patients experience clinically significant anxiety, with unmarried status as the strongest predictor. Routine APAIS screening can identify high-risk patients for targeted interventions.\u003c/p\u003e","manuscriptTitle":"Marital Status Supersedes Sex as the Primary Predictor of Preoperative Anxiety Among Elective Surgery Patients in Western India: A Cross-Sectional APAIS Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-04 06:43:22","doi":"10.21203/rs.3.rs-9236204/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-06T11:51:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"45583896387909183286451474202080371985","date":"2026-04-30T09:31:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-27T12:07:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"92421072710714226210948779942422336640","date":"2026-04-27T09:23:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"12405026244993198059047628745790707427","date":"2026-04-24T06:05:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-21T10:32:51+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-27T08:56:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-27T06:57:45+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T06:57:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2026-03-26T15:46:06+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ee771e92-c07e-4ee6-b24f-80a39d0b2b71","owner":[],"postedDate":"May 4th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-06T11:51:30+00:00","index":68,"fulltext":""},{"type":"reviewerAgreed","content":"45583896387909183286451474202080371985","date":"2026-04-30T09:31:06+00:00","index":66,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-04T06:43:22+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-04 06:43:22","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9236204","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9236204","identity":"rs-9236204","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}