Association between preoperative anxiety and case cancellations: Prospective study
Issued Date
2026-06-01
Resource Type
ISSN
09528180
eISSN
18734529
Scopus ID
2-s2.0-105035869537
Journal Title
Journal of Clinical Anesthesia
Volume
112
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Clinical Anesthesia Vol.112 (2026)
Suggested Citation
Ramishvili T., Khandaker R., Himes C., Beckham D., Schwarz J.N., Rojanapithayakorn N., Freda J., Strätz D., Suleiman A., Tufail B., Zmily O.M., Droege L., Alpert J.E., Alexander J., Masoumi S., Wongtangman K., Rego S.A., Fassbender P., Eikermann M. Association between preoperative anxiety and case cancellations: Prospective study. Journal of Clinical Anesthesia Vol.112 (2026). doi:10.1016/j.jclinane.2026.112205 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/116433
Title
Association between preoperative anxiety and case cancellations: Prospective study
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Diagnosed anxiety disorder is a predictor of same-day case cancellations. Many patients experience significant preoperative anxiety without a formal diagnosis. We investigated whether high preoperative anxiety independently predicts same-day case cancellations beyond established risk factors. Methods This prospective study was conducted at Montefiore Medical Center between April 2023 and January 2025. Anxiety was assessed one day preoperatively using a self-reported Numeric Rating Scale (NRS:0–10). High anxiety was defined as NRS ≥5. The primary outcome was same-day case cancellation. We used modified Poisson and logistic regressions to examine associations between exposure and outcome, adjusting for known predictors of same-day case cancellation. Results The final cohort included 6469 cases, of which 1248 (19.3%) reported high preoperative anxiety whereas only 9.5% of them had a documented anxiety diagnosis. The most frequently reported concerns were complications in surgery (1147 (17.7%)), postoperative complications (811 (12.5%)), and pain (682 (10.5%)). Same-day case cancellation rates were 6.0% (312/5221) for patients with low anxiety and 7.7% (96/1248) for those with high anxiety (risk difference 1.7% (95%CI (confidence interval): 0.1% –3.3%), p = 0.025). The attributable risk fraction of high anxiety for same-day case cancellation amounted to 22.1%. High anxiety was associated with an increased risk of case cancellation (adjusted risk ratio 1.29; 95%CI: 1.04–1.62; p = 0.023). An increase in each NRS anxiety score (0−10) was dose-dependently associated with added risk of case cancellation (adjusted odds ratio 1.04; 95%CI: 1.01–1.08; p = 0.019). Conclusions A significant level of preoperative anxiety occurs in one out of 5 patients and is an independent predictor of surgical case cancellations. One-fifth of same-day case cancellations in patients can be attributed to preoperative anxiety, which may potentially be addressed by a preoperative intervention.