Original article

Perioperative anxiety in major abdominal surgery: analysis of contributing factors using the Hamilton Anxiety Rating Scale (HAM-A)

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Abstract

Aim: To evaluate factors associated with perioperative anxiety in patients undergoing major abdominal surgery under general anaesthesia (GA) using the Hamilton Anxiety Rating Scale (HAM-A). 

Methods: This prospective observational study included 107 adult patients scheduled for major abdominal surgery under GA. Anxiety was assessed preoperatively and postoperatively using the HAM-A. Demographic characteristics, medical history, lifestyle habits, and perioperative variables were analysed. Multivariable analysis was conducted to identify factors independently associated with pre- and postoperative anxiety.

Results: Preoperative anxiety was observed in 54 patients (50.5%), while postoperative anxiety occurred in 34 patients (31.8%). Multivariable analysis identified alcohol consumption (β=8.10, 95%CI: 0.46-14.07; p=0.037), hyperlipoproteinemia (β=1.81, 95%CI: 1.42-2.19; p<0.001), preoperative fasting duration (β=0.03, 95%CI: 0.02-0.04; p=0.005), surgery duration (β= -0.45, 95%CI: -0.74- -0.13; p=0.006), and anaesthesia duration (β=0.43, 95%CI: 0.07-0.70; p=0.015) as factors independently associated with preoperative anxiety. The type of intravenous anaesthetic showed a trend toward significance (β= -5.45, 95%CI: -10.20-0.08; p=0.054). Factors independently associated with postoperative anxiety included age (β=0.08, 95%CI: 0.01-0.17; p=0.018), previous hospitalisations (β=6.43, 95%CI: 3.69-11.86; p < 0.001), previous surgeries (β=8.13, 95%CI: 6.25-14.44; p<0.001), and preoperative fasting duration (β=2.87, 95%CI: 1.90-4.79; p<0.001).

Conclusion: Routine assessment using the HAM-A scale may help identify high-risk patients and guide targeted perioperative strategies, including preoperative counselling and optimization of fasting protocols.

 

Keywords: perioperative care, general anesthesia, anxiety, surgery, HAM-A scale