Assessment of Factors Influencing Heightened Patient Anxiety Levels in the Operating Theatre: A Single-Centre Cross-Sectional Study
Authors and Affiliations
- Choitram Memorial Hospital, Freetown, Sierra Leone
- FOCOS Orthopedic Hospital, Accra, Ghana
- The Operating Room Global (TORG)
Corresponding author: Abu Sesay · [email protected]
Abstract
Background: Perioperative anxiety can intensify once patients enter the operating theatre, potentially affecting surgical outcomes and patient experience. Communication, patient characteristics and theatre environmental conditions may contribute.
Objective: To assess factors influencing heightened anxiety immediately before surgery and investigate associations with demographic characteristics, communication, specific fears and operating theatre environmental factors.
Methods: This quantitative descriptive cross-sectional study included 130 adult surgical patients at Choitram Memorial Hospital, Freetown, Sierra Leone, between 2 May and 5 June 2026. Convenience sampling and a structured questionnaire were used. Patients retrospectively rated anxiety at three perioperative stages on a 0–10 numerical rating scale. Data were analysed in SPSS version 28 using descriptive and nonparametric inferential statistics.
Results: Mean anxiety increased from 3.86 on the evening before surgery to 5.32 in the ward on the day of surgery, and 7.46 in the operating room immediately before anaesthesia. The increase was statistically significant (Friedman χ² = 173.322; p < 0.001; Kendall’s W = 0.667). Of 130 participants, 76 (58.5%) reported operating-room anxiety scores of 8–10, including 33 (25.4%) who scored 10. Environmental factors were positively associated with anxiety, particularly theatre atmosphere or sounds and the sight of surgical instruments. Demographic and measured communication factors were not significantly associated with operating-room anxiety.
Conclusion: Anxiety increased substantially as surgery approached. Immediate environmental exposure and specific fears showed stronger associations with anxiety than the demographic characteristics examined.
Keywords: Anxiety; Operating Theatre; Perioperative; Anaesthesia.
Study at a Glance
Study Participants
Adult surgical patients recruited at a single hospital in Freetown, Sierra Leone.
Mean Theatre Anxiety
Mean self-reported anxiety immediately before anaesthesia, compared with 3.86 the previous evening.
High Anxiety Scores
76 participants reported operating-room anxiety of 8–10 on the 0–10 scale.
Study Design and Main Findings
Design and Setting
Quantitative descriptive cross-sectional study at Choitram Memorial Hospital, Freetown, Sierra Leone; data collection from 2 May to 5 June 2026. Convenience sampling of adult elective-surgery patients.
Measurement and Analysis
Researcher-developed questionnaire, retrospective self-reported anxiety ratings across three perioperative stages, 11-point numerical rating scale (0–10), and SPSS version 28. Nonparametric tests assessed differences and associations.
Progression of Perioperative Anxiety
| Anxiety measurement | Mean (SD) | Median (IQR) |
|---|---|---|
| Evening before surgery | 3.86 (2.52) | 3.5 (2.0–5.0) |
| Ward on day of surgery | 5.32 (2.57) | 5.0 (4.0–7.0) |
| Operating room before anaesthesia | 7.46 (2.40) | 8.0 (6.0–9.75) |
Operating Theatre Environmental Factors
| Environmental factor | Spearman ρ | p-value |
|---|---|---|
| Operating room atmosphere or sounds | 0.508 | <0.001 |
| Seeing surgical instruments | 0.497 | <0.001 |
| Number of people in operating room | 0.368 | <0.001 |
| Seeing technical equipment | 0.361 | <0.001 |
| Waiting time before surgery | 0.351 | <0.001 |
Specific Fears Associated with Anxiety
Higher anxiety was associated with fear of surgical complications (p < 0.001), concern about family (p < 0.001), fear of disability or dependency (p = 0.001), fear of not waking after anaesthesia (p = 0.004), and fear of death (p = 0.024). Fear of postoperative pain and concerns about surgical results were not statistically significant in this study.
Demographic and Communication Findings
Age, gender, educational level and previous surgical experience were not significantly associated with operating-room anxiety. None of the measured communication variables showed a statistically significant association; nevertheless, 96.2% of participants indicated that more detailed explanations could reduce anxiety.
Interpretation, Implications and Limitations
Interpretation: The strongest observed associations concerned immediate theatre conditions and patients’ specific fears. The authors recommend considering reassessment of anxiety immediately before anaesthesia, minimising unnecessary exposure to surgical instruments, and addressing fears about complications, recovery and family.
Limitations: This was a single-centre study in a private tertiary hospital using convenience sampling. Anxiety ratings depended on retrospective recall after surgery; the numerical scale is not a diagnostic anxiety assessment. Binary communication questions may not fully capture communication quality. As an observational study, the findings establish associations, not causation.
Cite This Article
Publication Information
Article History
Received: 3 October 2026
Accepted: 22 October 2026
Available online: 25 October 2026
Journal and License
The Operating Room Global Journal (TORGJ)
ISSN: 3105-3262
Volume 2, Issue 4, December 2026
Pages 90–99
Creative Commons Attribution 4.0 International
Ethical Approval
FOCOS Orthopaedic Hospital Institutional Review Board. Approval dated 29 April 2026. Reference: FOCOS/IRB/26/04/002. Written informed consent was obtained.
Funding, Conflicts and Data
No external funding received. The authors declare no conflicts of interest. Anonymised data may be available from the corresponding author on reasonable request, subject to institutional approval.
Author Contributions and Declarations
Abu Sesay: Conceptualization, Methodology, Investigation, Data Curation, Writing – Original Draft.
Bright Worlanyo Aklamanu: Supervision, Methodology Review, Formal Analysis, Writing – Review & Editing.
Both authors reviewed and approved the final manuscript.
Artificial Intelligence Use Declaration
ChatGPT was used for editing and organising the research work, as declared in the published article.
Acknowledgements
The author acknowledges the TORG Global Research Fellowship Programme committee for opportunities for learning, collaboration and research development.
Full Article and References
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