Original article

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

Authors

• • Mirza Kovačević kovacevic.mirza@hotmail.com Email Mirza Kovačević. (compose email, opens in email app.) Mirza Kovačević ORCID profile. (opens in new tab)
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  • Department of Anaesthesiology, Resuscitation and Intensive Care, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
• • Anida Abazovic Bihorac
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  • Department of Neurology, Cantonal Hospital Zenica, Zenica, Bosnia and Herzegovina
• • Jasmina Smajic
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  • Clinic of Anaesthesiology, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina
• • Anel Okić Anel Okić ORCID profile. (opens in new tab)
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  • Faculty of Medicine
  • University of Zenica View ROR record for University of Zenica. (opens in new tab)
• • Ferid Krupic
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  • Department of Orthopaedics
  • University of Gothenburg View ROR record for University of Gothenburg. (opens in new tab)

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

How to Cite: Kovačević, M. , Abazovic Bihorac, A. , Smajic, J. , Okić, A. & Krupic, F. (2026) “Perioperative anxiety in major abdominal surgery: analysis of contributing factors using the Hamilton Anxiety Rating Scale (HAM-A)”, Medicinski glasnik. 23(2). doi: https://doi.org/10.17392/medglas-2164-23-2