Assessing Preoperative Anxiety: Comparison of three simple Anxiety Scales

Author(s): Roya Yumul, Ofelia Loani Elvir-Lazo, Paul F. White, Xiao Zhang, Waguih William IsHak, David Chernobylsky, Omar Durra, Hamed Sadeghipour.

Background: Preoperative anxiety is a significant concern for many patients undergoing elective surgery as it can negatively impact many aspects of anesthesia. Perioperative anxiety is associated with increased autonomic variability, higher anesthetic and analgesic requirements, and a greater incidence of nausea, vomiting, and pain during the early postoperative period. This prospective study was designed to compare the assessment of acute preoperative (state) anxiety using a visual analog scale (VAS), the Categorical Anxiety Scale (CAS) and a novel emoji-based Visual Facial Anxiety Scale (VFAS).

Methods: 293 adult patients undergoing elective surgical procedures were enrolled in this observational, prospective cohort study. In the preoperative evaluation area, anesthesia providers were questioned about their methods for assessing preoperative anxiety. After the anesthesiologists completed their evaluations and left the area, a co-investigator administered three anxiety assessment tools to the patients in a random order in the preoperative holding area before they entered the operating room.

Results: There was a significant correlation (p<0.0001) among the anxiety scores of the three simplified scales [VFAS vs VAS (r=0.738), VFAS vs CAS (r=0.759), and VAS vs CAS (r=0.861)]. The means and standard deviations of the score values for each of anxiety scales were: VFAS 2.02±0.94, VAS 3.39±2.5, and CAS 2.41±1.29. The times to perform the VFAS (7.3 ± 1.6 sec), VAS (7.2 ± 1.6 sec), and CAS (7.3 ± 1.9 sec) assessments were similar for the three scales. The patient’s top-ranked assessment scale was the VFAS (73%), followed by the VAS (15.6%) and the CAS (11%). The anesthesiologists’ top ratings were given to the VFAS (64%), followed by the VAS (22%), and the CAS (14%).

Conclusions: All three of the simple analog-based scales were highly correlated for assessing acute (state) anxiety and required only a short time to complete (<15 sec). The emoji-based scale was rated most highly by the patients.