I recently submitted this article as part of a writing assessment for a job interview. You can read more about my experience interviewing here. My article was only used as an assessment and was not going to be published, but since I spent so much time writing it, I thought you would benefit from the good information that it includes! This article focuses on the care of the anxious preoperative patient and heavily references the AORN Guideline for Complementary Care.
Preoperative Anxiety
Preoperative anxiety affects 60-80% of surgical patients1 and studies have shown that high levels of preoperative anxiety can negatively affect the surgical procedure and contribute to adverse patient outcomes, including pain management, patient safety, overall quality of care, and patient satisfaction.2,3
There are several sources for a patient’s uneasy feelings prior to surgery. Common fears, concerns, and anxieties experienced by patients preoperatively include:
- Fear of surgery and/or surgical outcome
- Fear of anesthesia
- Loss of control
- Fear of pain
- Fear of discrimination, judgement, or prejudice
- Financial concerns
- Concerns about provider expertise
- Fear of complications
- Concerns about home and work responsibilities
- Fear of diagnostic results
- Fear of death2,3,4,5
Complementary Care Interventions
Patients experiencing preoperative anxiety may benefit from a variety of complementary
care interventions that are intended to complement conventional treatments. Evidence
based interventions include:
- Supportive Education
- Music
- Stress Diversion
- Visualization
- Aromatherapy
- Acupoint
- Massage and Reflexology
Patients who are identified in the preoperative assessment as being highly anxious receive
significant benefit from complementary care interventions. Treatment should be
individualized, implemented as early as possible, and adjusted as needed based on the
patient’s response to the intervention. Interventions may be used individually or in
combination when appropriate (eg, aromatherapy and music), and when possible, the
patient should be allowed to select specific preferences related to each intervention.7
The following table outlines complementary care interventions that have been shown to
reduce preoperative anxiety and provides examples of each:
Informed consent should always be obtained prior to initiating any intervention. It is also
recommended that an interdisciplinary team review, select, and evaluate complementary
care interventions that will be used in the healthcare organization. The interdisciplinary
team should select interventions for their organization based on patient population, types
of procedures performed, and types of anesthesia administered.7
Conclusion
Preoperative anxiety can be caused by many different worries, concerns, or fears, and
influenced by previous negative surgical experiences or interactions with the medical
community. When left unaddressed, anxiety can negatively affect the patient’s surgical
experience, recovery, and outcome.
“Optimal perioperative nursing practice promotes patient well-being, and implementing
patient-centered complimentary care interventions can improve the perioperative
experience for patients and their families.”7
This is a ton of information, but I hope that it helps you see that there’s more we can do for preoperative anxiety than just give our patients another pill. There are a multitude of resources available, and many of the interventions can even be nursing driven – meaning if your facility implements them they’re available to you without having to get a doctor’s order first. Which is very helpful! I hope you take away something from this article that will help increase your awareness of preoperative anxiety and help improve your practice.
Until next time,
Melanie
Definitions:
- Preoperative Anxiety: feelings of tension, apprehension, nervousness, and worry in the
period leading up to surgery1 - Complementary Care: health approaches and practices that are used together with
conventional medicine, rather than in place of it, to complement treatment and improve
well-being6
References:
- Shebl MA, Toraih E, Shebl M, Tolba AM, Ahmed P, Banga HS, Orz M, Tammam M,
Saadalla K, Elsayed M, Kamal M, Abdulla M, Eldessouky AI, Moustafa YT, Mohamed
OA, Aiash H. Preoperative anxiety and its impact on surgical outcomes: A
systematic review and meta-analysis. J Clin Transl Sci. 2025 Jan 17;9(1):e33. doi:
10.1017/cts.2025.6. PMID: 40052059; PMCID: PMC11883570.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11883570/#ref1 - Bedaso 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 Mar
11;12(3):e058187. doi: 10.1136/bmjopen-2021-058187. PMID: 35277412; PMCID:
PMC8919464. https://pmc.ncbi.nlm.nih.gov/articles/PMC8919464/ - Bello CM, Eisler P, Heidegger T. Perioperative Anxiety: Current Status and Future
Perspectives. Journal of Clinical Medicine. 2025; 14(5):1422.
https://doi.org/10.3390/jcm14051422 https://www.mdpi.com/2077
0383/14/5/1422 - Cahyanto, Erindra Budi; Suratih, Kanthi; Setyani, Rizka Ayu1. Addressing
preoperative anxiety in surgical patients: A qualitative exploration of coping
mechanisms and healthcare support. Journal of Education and Health Promotion
14(1):439, October 2025. | DOI: 10.4103/jehp.jehp_1816_24
https://journals.lww.com/jehp/fulltext/2025/10310/addressing_preoperative_anxiet
y_in_surgical.439.aspx - Harding D, Marsh S, Lennie Y. Perioperative considerations for transgender and
gender diverse adults. BJA Education. 2023;23(4):136-143. doi:
https://doi.org/10.1016/j.bjae.2022.12.005 - National Center for Complementary and Integrative Health. Complementary,
alternative, or integrative health: What’s in a name? National Center for
Complementary and Integrative Health. Published 2021.
https://www.nccih.nih.gov/health/complementary-alternative-or-integrative-health
whats-in-a-name - AORN Guideline for Complementary Care
- Graff V, Cai L, Badiola I, et al. Music versus midazolam during preoperative nerve
block placements: a prospective randomized controlled study. Regional Anesthesia
& Pain Medicine 2019;44:796-799. https://rapm.bmj.com/content/44/8/796 - Chand SP, Marwaha R. Anxiety. [Updated 2023 Apr 24]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK470361/ - Baagil H, Baagil H, Gerbershagen MU. Preoperative Anxiety Impact on Anesthetic
and Analgesic Use. Medicina (Kaunas). 2023 Nov 23;59(12):2069. doi:
10.3390/medicina59122069. PMID: 38138172; PMCID: PMC10744982.
