Anxiety and Its Impact on Post-Operative Recovery in Ambulatory Surgery Patients: A Comprehensive Analysis

Abstract

Background

Pre-operative anxiety is a prevalent concern among patients undergoing ambulatory surgery, with studies indicating it affects up to 80% of surgical candidates. Anxiety can significantly disrupt the perioperative experience, contributing to physiological stress, delayed recovery, and higher complication rates (Mitchell, 2010; Stamenkovic ,2018). Despite this, the mechanisms linking anxiety to recovery outcomes remain underexplored, particularly in the context of same-day surgical procedures.

Objective

This study aims to evaluate the predictive role of pre-operative anxiety on post-operative recovery in ambulatory surgery patients. It also investigates the effectiveness of current anxiety management strategies, addressing gaps in existing perioperative care practices.

Methods

This multicenter observational cohort study involved 500 adult patients undergoing elective ambulatory surgeries. Pre-operative anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) (Spielberger ,1983). Recovery outcomes were measured using the Quality of Recovery-15 (QoR-15) score (Chazapis ,2016), visual analog scale (VAS) for pain, and time-to-mobility indices. Statistical analyses included regression modeling to evaluate anxiety as a predictor of recovery delays and mediation analysis to explore pain and mobility as intermediaries.

Results

High pre-operative anxiety levels (STAI > 40) were observed in 60% of the cohort and were significantly associated with poorer recovery scores (mean QoR-15: 92.1 vs. 104.3, p < 0.001). Patients with high anxiety had a 2.8-fold increased risk of delayed recovery (95% CI: 1.9–4.0). Mediation analysis revealed that pain perception accounted for 30% of the anxiety-recovery association. Interventions such as pre-operative counseling showed a moderate effect in reducing anxiety and improving outcomes (Johnston & Vogele, 1993).

Conclusions

Pre-operative anxiety significantly predicts delayed recovery in ambulatory surgery patients, with pain perception serving as a key intermediary. Routine anxiety screening and targeted interventions, including pre-operative counseling and mindfulness strategies, should be integrated into standard perioperative care to optimize recovery outcomes. Future research should explore scalable digital tools for anxiety management and their impact on recovery trajectories (Leung & Wormald, 2020).