Preoperative anxiety is associated with postoperative cardiovascular events, extubation delay, and pain in patients undergoing cardiac surgery: A prospective observational study in Taiwan.

OBJECTIVE

Preoperative anxiety is common among patients undergoing cardiac surgery and may influence early postoperative recovery. Evidence linking anxiety to clinically relevant postoperative outcomes remains limited, particularly in non-Western populations. This study examined the association between preoperative anxiety and multiple postoperative outcomes in patients undergoing cardiac surgery in Taiwan.

METHODS

In this prospective observational study, 113 adult patients scheduled for elective cardiac surgery were enrolled at a tertiary medical center in Eastern Taiwan. Preoperative anxiety was assessed using the Visual Analogue Scale for Anxiety (VAS-A; 0-10 scale). Outcomes included cardiovascular adverse events and non-arrhythmia-related cardiovascular events within 30 days postoperatively, delayed extubation (≥6 h), and mean 7-day postoperative pain, defined as a Critical-Care Pain Observation Tool score ≥ 2. Associations were evaluated using multivariable Firth's penalized logistic regression. Absolute risk estimates were derived at representative low and high anxiety levels.

RESULTS

Higher preoperative VAS-A scores were independently associated with increased odds of cardiovascular adverse events (adjusted odds ratio [aOR], 1.34), non-arrhythmia-related cardiovascular events (aOR, 1.40), and delayed extubation (aOR, 1.40). The association with mean 7-day postoperative pain approached but did not reach conventional statistical significance after adjustment (aOR, 1.18). Absolute risk estimates demonstrated substantial differences across anxiety levels for all outcomes.

CONCLUSION

Preoperative anxiety is independently associated with several adverse postoperative outcomes after cardiac surgery. These findings support the potential value of brief preoperative anxiety screening as a pragmatic tool for perioperative risk identification. Further studies are needed to determine whether targeted anxiety management can improve postoperative clinical outcomes.