The Relationship Between Fear of Surgery and Affecting Factors in Surgical Patients

doi:10.21203/rs.3.rs-2230326/v1

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The Relationship Between Fear of Surgery and Affecting Factors in Surgical Patients

https://doi.org/10.21203/rs.3.rs-2230326/v1

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published 08 Jun, 2023

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Background: This study aimed to explain the fear of surgery in surgical patients, the affecting factors, and their relationship.

Methods:This study was conducted as a descriptive and cross-sectional study. The study population consists of 300 patients undergoing surgical intervention. Data were collected using the "Patient Information Form" and "Surgical Fear Questionnaire". Parametric and nonparametric tests were used to evaluate the data. The relationship between the fear questionnaireand age, number of previous surgeries, and pre-operative pain were evaluated using Spearman correlation analysis. The relationship with emotional stress was evaluated with multiple linear regression analysis.

Results: In this study, it was determined that the predictors of the surgical fear level of the patients were age, gender, anesthesia type, and pre-operative pain experience. There was a negative correlation between the age of the patients and the fear of surgery score and a positive correlation between the pre-operative pain severity and the fear of surgery score. It was determined that the factors most associated with pre-operative fear levels were the patients' pre-operative sense of inadequacy (p <0.001), feeling anxious and unhappy, and confusion about the surgery decision (p <0.005).

Conclusion: According to the results of this study, it has been determined that the emotional states and fears of the patients before the surgery have significant effects on the fear of surgery. For this, it is recommended to determine the emotional states and fears of the patients before the surgery and to make appropriate interventions, as it will facilitate compliance with the surgical process.

Pre-operative period

Fear of Surgery

Surgery

Nursing

Having surgery is an experience that creates anxiety and fear in individuals. Pre-operative fear is a typical emotional response in many patients awaiting surgery (1). Anxiety can be seen in 60–80% of patients before surgery (2, 3). The reasons for the anxiety of the patients before the surgery are uncertainty about the disease and the future, lack of information about the operation process, inability to wake up from anesthesia, lifestyle changes, deterioration in body image, postoperative pain, disability, and fear of death (4).

Anxiety and fear before surgery can affect postoperative wound healing, pain and anesthesia intensity, and analgesia requirements (5–7). In this process, the stress response affects wound healing directly and indirectly. The direct effect is due to stress hormones (cortisol, epinephrine, norepinephrine), while the indirect effect is due to the type of anesthesia, general health status before the surgery, and the effects of habits such as smoking and alcohol (4, 8, 9).

Emotional well-being in the pre-operative period also affects physiological and psychological recovery in the postoperative period. In the literature, the level of anxiety and fear in surgical patients was found to be higher in women, those who came to surgery alone, patients who would undergo major surgery such as cardiac and vertebral surgery, young people, and those with bad anesthesia experience (5, 10–15). For this reason, planning the surgical process by considering these factors in the pre-operative period is essential.

Many studies deal with patients’ emotional, social, and individual factors and their effects on various health parameters. It is also argued that these factors may affect the course of acute and chronic disease and the recovery and survival of patients (16, 17). In addition, it is stated in the literature that pre-operative anxiety and fear increase the intensity of postoperative pain and cause the individual to need more analgesics and have difficulty controlling pain (7, 18–22).

It is imperative to reveal the factors affecting the fear and explain the relationships of these factors in planning the right interventions for the patients to make the proper intervention regarding the patients' fears in the pre-operative period. However, studies examining the relationship between these factors, which are thought to affect pre-operative fear, are limited in the literature. This study explained the pre-operative fear levels of patients undergoing surgical intervention and the relationship between the affecting factors.

This was a cross-sectional, descriptive, and correlational study. The study was conducted between February and May 2021 with inpatients in the surgical clinics (brain and neurosurgery, general surgery, thoracic surgery, orthopedics and traumatology, urology) of a hospital with a 679-bed capacity and the pre-operative period for surgical procedures. Using G* Power 3.1.9.4 software to calculate the sample size, the number of people to be sampled was determined as 262 with 95% power and 5% type 1 error rate (23), but 300 people were included in the sample considering the data losses.

To determine the fear of surgery more objectively, the surgical interventions to be applied to patients with an equal number of minor and major surgeries from each surgery clinic were included (Table 1). The surgical classification was based on previous studies that considered various criteria such as blood loss, degree of pain and opening of a body cavity (e.g., abdomen, chest), need for monitoring, and length of hospital stay (24, 25).

Table 1

Surgical classification of patients included in the study
Surgery Classification
Minor surgery (n = 150)	-In neurosurgery, general surgery, thoracic surgery, orthopedics and traumatology, urology services -Pleural surgeries, cholecystectomy, minor head trauma, minor cyst surgery, transurethral resection, hernia surgery, minimally invasive thoracic surgery, thyroidectomy, colostomy closure, breast reconstruction, external fixator removal, percutaneous nephrolithotomy, etc.
major surgery (n = 150)	- In neurosurgery, general surgery, thoracic surgery, orthopedics and traumatology, urology services - Oncological surgeries, Whipple, total hip replacement, total knee replacement, fracture surgeries, prostatectomy, spinal surgery, mastectomy, cystectomy, pneumonectomy, spine surgery, gastrectomy, pancreatectomy, hepatectomy, etc.

Inclusion criteria for the study: (1) 18 years of age or older, (2) elective surgery is planned and is in the pre-operative process, (3) ASA I-III classified, and (4) can communicate in Turkish. Patients with a history of using drugs (antidepressant, antipsychotic, anxiolytic) affecting the central nervous system, a psychiatric disease, mental retardation, and did not want to participate in the study were excluded from the study.

Between the data collection dates, 330 patients were included in the study. However, the study was terminated with 300 patients because seven had used antipsychotic and antidepressant drugs, four refused to participate, and 19 had undergone emergency surgery (Fig. 1).

Data Collection And Tools

In this study data were collected using the patient information form and the Surgical Fear Questionnaire.

Patient Information Form; the researchers create questions to determine the patients' demographic data, the data about the surgery, and the emotional stress. Stress-related questions were formed by using the “The Brief Measure of Emotional Preoperative Stress Scale” (25). Pre-operative stress questions were asked in a yes/no format.

Surgical Fear Questionnaire (SFQ); this determines the level of fear of patients who will undergo elective surgery (26). A Turkish validity and reliability study was conducted in 2018 (27). The questionnaire, consisting of eight items, has an 11-Likert structure. Each item is scored as 0, “not afraid at all,” and 10, “very afraid.” The questionnaire has two sub-dimensions, each consisting of four items, showing the fear of surgery's short and long-term results. The subscale score is obtained by adding the scores of the four items in the sub-dimensions of the questionnaire, and the total score of the questionnaire is formed by adding the scores of the two subscales. The total questionnaire score is 0 at the lowest and 80 at the highest. A high score indicates a heightened fear of surgery. In this study, the mean score of the Surgical Fear Questionnaire was 18.04 ± 20.38, the mean score of the short-term sub-dimension (SFQ-S) was 9.49 ± 10.86, and the mean score of the long-term sub-dimension (SFQ-L) was 8.55. ±11.58. The Cronbach's a coefficient of the adapted scale was 0.93 (27). In our study, the Cronbach a coefficient of the scale was 0.88.

In data collection, patients were visited in the patient rooms of the clinic the day before the surgery, the purpose of the study was explained, and informed consent was obtained from the individuals who agreed to participate in the study. In the pre-operative period, the Patient Information Form and SFQ were applied to the patients. It took an average of 5–7 minutes for the patients to respond to the questionnaires.

Statistical Analysis

Data analysis was performed using the SPSS (Statistical Package for the Social Sciences) 24.0 program. The conformity of the data to the normal distribution was checked with kurtosis-skewness. To compare descriptive statistics and groups, independent samples t-test and ANOVA were used for normally distributed data, and Mann-Whitney U and Kruskal Wallis tests were used for data that did not conform to normal distribution. The relationship between scale total score and sub-dimension scores, age, number of previous surgeries, and pre-operative pain was evaluated by Spearman correlation analysis. The effect of items measuring the emotional stress of the patients on the fear scale total score was evaluated with multiple linear regression analysis. In all results, p < 0.05 was considered statistically significant.

The mean age of the patients in this study was 54.29 ± 14.45 (18–88). It was determined that 56% of the patients were male, 76.7% had previous surgery, and 31.3% of those who had surgery had more than three surgeries. 50.7% of the patients were hospitalized for major surgery, open surgery was planned for 44.7%, general anesthesia was applied to 89.0%, 39.7% experienced pain, and 23.53% of the patients with pre-operative pain felt pain of 7–10 severity (Table 2).

Table 2

Basic characteristics of the patients
Characteristics	Mean ± SD
Age (Year) (Min-max)	54.29 ± 14.45 (18–88)
Age groups	n (%)
18–44 years old	71(23.7)
45–64 years old	145(48.3)
65 years and older	84(28.0)
Gender
Female	132(44.0)
Male	168(56.0)
History of surgery
Yes	230(76.7)
No	70(23.3)
Number of previous surgeries (n = 230)
One	99(43.04)
Two	59(25.65)
three or more	72(31.30)
Classification of current surgery
Minor surgery	148(49.3)
Major surgery	152(50.7)
Type of current surgery
Open surgery	134(44.7)
Laparoscopic surgery	166(55.3)
Type of current anesthesia
General anesthesia	267(89.0)
Epidural anesthesia	33(11.0)
Pre-operative pain
Yes	119(39.7)
No	181(60.3)
Pre-operative pain severity (n = 119)
Between 1–3	44(36.97)
Between 4–6	47(39.49)
Between 7–10	28(23.53)

According to the answers to the questions asked to determine the emotional stress levels before the surgery, 58% of the patients felt jittery, 16.3% were indecisive about having the surgery, 59.3% were worried, and 31.7% were confused. It was determined that 13% felt failure about surgery, 72.3% remained under the influence of disappointments for a long time, 83.3% constantly thought about their problems and worried, and 26.3% felt unhappy before the surgery (Fig. 2).

When the relationship between the basic characteristics of the patients participating in the study and the surgical fear questionnaire and sub-dimension average score was examined, it was determined that the fear ranking average score of the patients aged 18–44 years, female, who had surgery in neurosurgery and thoracic surgery clinics was higher. The fear scale mean score of the patients who were to be operated on under general anesthesia and who had severe pain before the operation is higher (p < 0.005) (Table 3).

Table 3

The relationship between the descriptive and surgical characteristics of the patients and the fear of surgery scale
	SFQ-S	SFQ-L	SFQ total
Age groups	x̄ ± SD	x̄ ± SD	x̄ ± SD
18–44 years old	12.41 ± 11.49	11.48 ± 12.35	23.89 ± 22.19
45–64 years old	9.15 ± 10.24	7.62 ± 10.98	16.77 ± 18.93
65 years and older	7.61 ± 10.98	7.68 ± 11.67	15.29 ± 20.51
p ^*	0.020	0.051	0.018
Gender
Female	13.69 ± 11.83	10.92 ± 12.55	24.62 ± 21.99
Male	6.18 ± 8.74	6.68 ± 10.44	12.86 ± 17.43
p ^**	0.000	0.002	0.000
Surgical clinic
Orthopedics	9.50 ± 11.06	8.63 ± 11.38	18.13 ± 20.18
General surgery	9.00 ± 10.20	6.68 ± 10.23	15.68 ± 18.88
Brain surgery	11.11 ± 11.27	10.85 ± 12.18	21.95 ± 21.71
Urology	7.22 ± 10.37	6.60 ± 10.88	13.83 ± 19.69
Thoracic surgery	11.33 ± 11.98	11.63 ± 14.43	22.96 ± 23.28
p *******	.156	.045	.040
History of surgery
Yes	9.53 ± 10.86	8.68 ± 11.54	18.21 ± 20.19
No	9.34 ± 10.94	8.13 ± 11.82	17.47 ± 21.15
p **	0.897	0.729	0.790
Type of current surgery
Open surgery	10.09 ± 10.73	8.647 ± 11.45	18.76 ± 20.38
Laparoscopic	9.00 ± 10.98	8.45 ± 11.73	17.45 ± 20.43
p **	0.389	0.867	0.579
Classification of current surgery
Minor surgery	10.54 ± 11.32	8.96 ± 11.87	19.50 ± 20.98
Major surgery	8.47 ± 10.33	8.15 ± 11.33	16.62 ± 19.76
p ********	0.089	0.628	0.172
Type of current anesthesia
General anesthesia	10.08 ± 11.05	9.19 ± 11.93	19.27 ± 20.88
Epidural anesthesia	4.73 ± 7.85	3.36 ± 6.34	8.09 ± 12.10
p ********	0.005	0.007	0.001
Pre-operative pain
Yes	12.13 ± 12.12	10.47 ± 12.85	22.60 ± 22.98
No	7.76 ± 9.59	7.29 ± 10.52	15.04 ± 17.92
p **	0.001	0.025	0.003
Pre-operative pain intensity
Between 1–3	8.39 ± 9.96	7.49 ± 10.55	15.88 ± 18.30
Between 4–6	10.89 ± 12.23	9.72 ± 12.51	20.62 ± 23.46
Between 7–10	15.96 ± 13.08	15.11 ± 15.53	31.07 ± 25.68
p *******	0.006	0.068	0.011
* One Way ANOVA
** Independent sample t-test
*** Kruskal Wallis test
****Mann Whitney U test

In the Spearman correlation analysis, in which the relationship between the total fear scale score of the patients participating in the study and age, the number of previous surgeries, and pre-operative pain severity were examined, a negative correlation was found between age and fear score, and a weak positive correlation between pre-operative pain severity and fear score (p < 0.005) (Table 4).

Table 4

The relationship between the Surgical Fear Questionnaire and some variables
	x̄ ± SD ( min-max )	p	r^s
Age (Year)	54.29 ± 14.45 (18–88)	0.010	− .148
Number of previous surgeries	1.93 ± 2.76 (0–30)	0.301	.537
Pre-operative pain intensity	1.93 ± 2.77 (0–10)	0.004	.168
r^s: Spearman correlation analysis

It was determined that the regression model was statistically significant in the multiple linear regression analysis in which the relationship between the patients' pre-operative emotional stress and their pre-operative fear levels was examined (p < 0.001; R ² _adjusted =0.47). It was determined that the factors most associated with preoperative fear levels were the patients' pre-operative sense of failure (p < 0.001), feeling worried and unhappy, and confusion about the surgery decision (p < 0.005) (Table 5).

Table 5

Multiple linear regression analysis of the Surgical Fear Questionnaire total score and some independent variables
Independent variables	B	SE	β	t	p	95% confidence interval
Independent variables	B	SE	β	t	p	lower limit	upper limit
Do you feel jittery?	5,877	5.331	.143	1.606	.109	-1.327	13,081
Do you feel indecisive?	5,580	3.660	.101	1,919	.056	− .143	11,303
Do you feel worried?	7.688	2.908	.186	2,079	.038	.411	14,965
Do you feel confused?	5,150	3.698	.118	2,066	.040	.245	10,056
Do you feel like a failure?	16,442	2,492	.272	5.449	.000	10,503	22,380
Do you stay under the influence of disappointments for a long time?	3,210	3,017	.071	1.151	.251	-2,280	8,700
Do you constantly think and worry about your problems?	2.303	2,789	.042	.704	.482	-4,135	8,741
Do you feel unhappy?	4,747	3.271	.103	2.034	.043	.153	9,340
R ² _corrected =0.47
B: Non-standardized regression coefficient, SE: Standard error, β: standardized regression coefficient
p < 0.005

Surgery is an experience that causes many patients emotional reactions such as fear and anxiety. The lifetime prevalence of fear or anxiety arising from surgical procedures and/or medical interventions is 12.8% (28, 29). This study discusses the pre-operative fear levels of the patients undergoing surgical intervention and the relationship between the affecting factors.

In the literature, it is seen that anxiety and fear experienced in the pre-operative period vary depending on age, gender, marital status, education level, type of surgery, anesthesia, fear of postponing the surgery, fear of waking up early from anesthesia, fear of postoperative pain, fear of financial loss, and fear of death (15, 23, 30–36). In this study, following the literature, it was determined that young patients had a higher level of fear than older patients, and female patients had a higher level of fear than men. The lower level of fear of elderly patients can be attributed to their familiarity with the hospital environment. After all, they apply to the hospital more frequently due to chronic diseases (37) and the fact that they experience less fear because they see old age as approaching death and accepting it. It is thought that women have higher levels of fear than men may be related to the effects of estrogen-progesterone hormones on emotional changes (38, 39) and to psychosocial stress, such as family responsibilities and inability to fulfill their caregiver role in the family. In addition, although men are reluctant to express their emotions, women's more comfortable expression of emotions (40) may have revealed this result. The study determined that the fear level of patients who underwent surgery in clinics such as neurosurgery and thoracic surgery under general anesthesia was higher. It can be said that this situation develops due to the inability to wake up from general anesthesia and the fear of being disabled after surgery. The study is similar to the literature (41, 42).

Many patients may fear experiencing pain in the postoperative period (43). This situation may cause patients to be afraid of having surgery and to postpone the decision or to be indecisive about it. It is seen in the literature that this fear is higher in patients who have severe pain in the pre-operative period (26, 44). In this study, it was seen that 39.7% of the patients had pain, and 23.53% had severe pain before the surgery. It was determined that these patients’ fear questionnaire mean scores were higher than the others. The study is similar to the literature.

The study determined that the factors most associated with pre-operative fear levels were pre-operative anxiety, unhappiness, confusion about the surgery decision, and having a sense of inadequacy. These patients experienced higher fear of surgery. Not having enough information about the pre-operative and postoperative process and being prone to anxiety as a personality can be the reason for these feelings. In addition, it can be expected that the neuroendocrine response caused by anxiety and fear will change physiological parameters, and these feelings will deepen. This may lead to difficulty adapting to the treatment process, an increase in postoperative complications, prolongation of the healing process, and delayed discharge(45–50).

In this study, it was determined that female patients, young people, patients receiving general anesthesia, and patients with high pre-operative pain had a higher fear of surgery, and pre-operative anxiety, unhappy, confused, and feelings of inadequacy were essential factors associated with fear of surgery. For this, it is recommended to determine the emotional states and fears of the patients before the operation and to make appropriate interventions, as it will facilitate compliance with the surgical process.

Since the application was conducted with patients in a single center, the results obtained from the study can only be generalized to the patient group participating in the study.

Surgical Fear Questionnaire: SFQ

Surgical Fear Questionnaire Short-term Sub-dimension: SFQ-S

Surgical Fear Questionnaire Long-term Sub-dimension: SFQ-L

Ethics approval and consent to participate

Ethics committee approval (2021/132) and institutional permissions were obtained from the Clinical Research Ethics Committee before starting the study. The patients participating in the study were informed about the study and their written consent for participation was obtained. It was explained to the patients that their answers would be kept confidential and that the information provided would only be used within the scope of the research. They were told that participation in the study was voluntary and that they could leave it at any time. Ethical principles such as patient privacy and informed consent were followed to protect patient rights.

Consent for publication

Not applicable

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This research was not financially supported.

Authors' contributions

SA made substantial contributions to the conception and design, acquisition of data and; analysis and interpretation of data and; revised it critically for important intellectual content and; given final approval of the version to be published and; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

OC made substantial contributions analysis and interpretation of data and; drafted the article and;given final approval of the version to be published and; agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Acknowledgements

The authors would like to thank all the participants and the surgical team involved in the study.

Theunissen M, Jonker S, Schepers J, Nicolson NA, Nuijts R, Gramke HF, et al. Validity and time course of surgical fear as measured with the Surgical Fear Questionnaire in patients undergoing cataract surgery. PLoS One. 2018;13(8):1–19.
Karayağız F, Altuntaş M, Güçlü Y, Yılmazer T, Öngel K. Cerrahi servisinde yatan hastalarda görülen anksiyete dağılımı. Smyrna Tıp Derg. 2011;22–6.
Guerrier G, Pisanu G, Baillard C. Assessing Preoperative Anxiety: Nurses Versus Health Care Assistants. J Perianesthesia Nurs. 2021;36(5):514–7.
Karadağ M. Homeostazis ve Cerrahi Stres. In: Karadağ M, Bulut H, editors. Kavram Haritası ve Akış Şemalı Cerrahi Hemşireliği 1. Ankara: Vize Yayıncılık; 2019. p. 23–46.
Stamenkovic DM, Rancic NK, Latas MB, Neskovic V, Rondovic GM, Wu JD, et al. Preoperative anxiety and implications on postoperative recovery: What can we do to change our history. Minerva Anestesiol. 2018;84(11):1307–17.
Maeshi MMM, Maashi FMM, Muhammed Hummadi MH, Alhamoud RMH, Ayashi MMH, Refaei NAA. Perioperative Anxiety and Intraoperative Anesthetic Requirements. Indo Am J Pharm Sci. 2018;05(12):17259–63.
Sidar A, Dedeli Ö, İşkesen Aİ. Açık Kalp Cerrahisi Öncesi ve Sonrası Hastaların Kaygı ve Ağrı Distresi : Ağrı Düzeyi ile İlişkisinin İncelenmesi. Yoğun Bakım Derg. 2013;4:1–8.
Sürme Y. Stres, Stresle İli̇şki̇li̇ Hastalıklar ve Stres Yöneti̇mi̇. J Int Soc Res. 2019;12(64):525–9.
Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Bandeira D, et al. Risk factors for preoperative anxiety in adults. Acta Anaesthesiol Scand. 2001;45(3):298–307.
Cimilli C. Cerrahide Anksiyete. Klin Psikiyatr Derg. 2001;4:182–6.
Fındık ÜY, Yıldızeli Topçu S. Cerrahi Girişime Alınış Şeklinin Ameliyat Öncesi Anksiyete Düzeyine Etkisi. Sağlık Bilim Fakültesi Hemşirelik Derg. 2012;22–33.
Karadağ Arlı Ş. Ameliyat Öncesi Anksiyetenin APAIS ve STAI-I Ölçekleri İle Değerlendirilmesi. Hacettepe Üniversitesi Hemşirelik Fakültesi Derg. 2017;4(3):38–47.
Arslan S, Taylan S, Deniz S. Nöroşirürji Hastalarının Ameliyat Öncesi Anksiyete Düzeyleri. Anadolu Hemşirelik ve Sağlık Bilim Derg. 2017;20(1):17–21.
Kaynar şimşek A, Şimşek T, Ecevit Alpar Ş. Açık Kalp Ameliyat Olacak Hastalara Verilen Preoperatif Eğitimin: Postoperatif Dönemde Anksiyete ve İyileşme Süreci Üzerine Etkisinin İncelenmesi. Ege Üniversitesi Hemşirelik Fakültesi Derg. 2018;34(3):45–62.
Çelik F, Edipoğlu İS. Evaluation of preoperative anxiety and fear of anesthesia using APAIS score. Eur J Med Res. 2018;23(41):1–10.
Levett DZH, Grimmett C. Psychological factors , prehabilitation and surgical outcomes : evidence and future directions. 2019;74:36–42.
Mavros MN, Athanasiou S, Gkegkes ID, Polyzos KA, Falagas ME. Do Psychological Variables Affect Early Surgical Recovery ? PLoS One. 2011;6(5):1–6.
Robleda G, Sillero-Sillero A, Puig T, Gich I, Baños JE. Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery. Rev Lat Am Enfermagem. 2014;22(5):785–91.
Socea SD, Abualhasan H, Magen O, Zayit-Soudry S, Blumenthal EZ, Duvdevan N, et al. Preoperative Anxiety Levels and Pain during Cataract Surgery. Curr Eye Res. 2020;45(4):471–6.
Peker K. Preoperatif Anksiyetenin Değerlendirilmesinde Beck ve Durumluk- Sürekli Anksiyete Ölçeklerinin Karşılaştırılması. JARSS Anestezi Derg. 2020;28(2):109–15.
Taşdemir A, Erakgün A, Deniz MN, Çertuǧ A. Preoperatif bilgilendirme yapılan hastalarda ameliyat öncesi ve sonrası anksiyete düzeylerinin state-trait anxiety inventory test ile karşılaştırılması. Türk Anesteziyoloji ve Reanimasyon Derneği Derg. 2013;41(2):44–9.
Kandemir E, Aşkın T, Kandemir T, Tuncel OG, Ünver S. The effect of anxiety on postoperative pain expectation and opioid consumption in modified radical mastectomy operations. Ortadoğu Tıp Derg. 2019;11(2):136–42.
Işıklı AG, Kızılcık Özkan Z, Buberka Z. The Fear of Surgery and Coronavirus in Patients Who Will Undergo a Surgical Intervention. J PeriAnesthesia Nurs. 2022;00:1–5.
Stavrou G, Panidis S, Tsouskas J, Tsaousi G, Kotzampassi K. An Audit of Operating Room Time Utilization in a Teaching Hospital: Is There a Place for Improvement? ISRN Surg. 2014;2014:1–6.
Caumo W, Nazare Furtado Da Cunha M, Camey S, Maris De Jezus Castro S, Torres ILS, Cadore Stefani L. Development, psychometric evaluation and validation of a brief measure of emotional preoperative stress (B-MEPS) to predict moderate to intense postoperative acute pain. Br J Anaesth. 2016;117(5):642–9.
Theunissen M, Peters ML, Schouten EGW, Fiddelers AAA, Willemsen MGA, Pinto PR, et al. Validation of the surgical fear questionnaire in adult patients waiting for elective surgery. PLoS One. 2014;9(6):1–9.
Bağdigen M, Karaman Özlü Z. Validation of the Turkish Version of the Surgical Fear Questionnaire. J Perianesthesia Nurs. 2018;33(5):708–14.
Schmid M, Wolf RC, Freudenmann RW, Schönfeldt-Lecuona C. Tomophobia, the phobic fear caused by an invasive medical procedure - An emerging anxiety disorder: A case report. J Med Case Rep. 2009;3(131):1–4.
Becker ES, Rinck M, Türke V, Kause P, Goodwin R, Neumer S, et al. Epidemiology of specific phobia subtypes: Findings from the Dresden Mental Health Study. Eur Psychiatry. 2007 Mar 1;22(2):69–74.
Sigdel DS. Perioperative anxiety: A short review. Glob Anesth Perioper Med. 2015;1(4):107–9.
Ghimire R, Poudel P. Preoperative Anxiety and Its Determinants Among Patients Scheduled for Major Surgery: A Hospital Based Study. J Anesthesiol. 2018;6(2):57–60.
Kuzminskaitė V, Kaklauskaitė J, Petkevičiūtė J. Incidence and features of preoperative anxiety in patients undergoing elective non-cardiac surgery. Acta medica Litu. 2019;26(1):93–100.
Erkilic E, Kesimci E, Soykut C, Doger C, Gumus T, Kanbak O. Factors associated with preoperative anxiety levels of Turkish surgical patients: From a single center in Ankara. Patient Prefer Adherence. 2017;11:291–6.
Sürme Y, Cimen Ö. Preoperative Surgical Fear and Related Factors of Patients Undergoing Brain Tumor Surgery. J Perianesthesia Nurs. 2022;000:1–5.
Kaya M, Karaman Özlü Z. Elektif Cerrahi̇ Bekleyen Hastalarda Cerrahi̇ Korkunun Sosyal Destek Algısı İli̇şki̇si̇ni̇n Beli̇rlenmesi̇. Anadolu Hemşirelik ve Sağlık Bilim Derg. 2019;22(4):281–90.
Ruhaiyem ME, Alshehri AA, Saade M, Shoabi TA, Zahoor H, Tawfeeq NA. Fear of going under general anesthesia: A cross-sectional study. Saudi J Anaesth. 2016;10(3):317–21.
Oymaagaclıo K, Ates S. Identifying Factors Affecting Anxiety Levels in the Patients Planned for Cataract Surgery : A Crossectional Study. Int J Caring Sci. 2019;12(2):639–48.
Li SH, Graham BM. Why are women so vulnerable to anxiety , trauma-related and stress-related disorders ? The potential role of sex hormones. The Lancet Psychiatry [Internet]. 2017;4(1):73–82. Available from: http://dx.doi.org/10.1016/S2215-0366(16)30358-3
Albert KM, Newhouse PA. Estrogen, Stress, and Depression: Cognitive and Biological Interactions. Annu Rev Clin Psychol. 2019;15:399–423.
Masjedi M, Ghorbani M, Managheb I, Fattahi Z, Dehghanpisheh L, Salari M, et al. Evaluation of anxiety and fear about anesthesia in adults undergoing surgery under general anesthesia. Acta Anaesthesiol Belg. 2017;68(1):25–9.
Alodaibi FA, Fritz JM, Thackeray A, Koppenhaver SL, Hebert JJ. The fear avoidance model predicts short-term pain and disability following lumbar disc surgery. PLoS One. 2018;13(3):1–11.
Roublah E, Alqurashi R, Kandil M, Neama S, Roublah F, Arab A, et al. Patients’ concerns and perceptions of anesthesia-associated risks at University Hospital: A cross-sectional study. Saudi J Anaesth. 2020;14(2):157–63.
Ustunel F, Erden S. Evaluation of Fear of Pain Among Surgical Patients in the Preoperative Period. J PeriAnesthesia Nurs [Internet]. 2022;37(2):188–93. Available from: https://doi.org/10.1016/j.jopan.2021.02.003
Hoofwijk DMN, Fiddelers AAA, Peters ML, Björn S, Kessels AGH, Joosten EA, et al. Prevalence and predictive factors of chronic postsurgical pain and poor global recovery 1 year after outpatient surgery. Clin J Pain. 2015;31(12):1017–25.
Bansal T, Joon A. Preoperative anxiety-an important but neglected issue: A narrative review. Indian Anaesth Forum. 2016;17(2):37.
Şahin Altın Ö, Karaman Özlü Z, Olçun Z, Kaya M. Does the Fear of Surgery Prevent Patients From Sleeping. Anadolu Hemşirelik ve Sağlık Bilim Derg. 2017;20(4):260–6.
Manou-Stathopoulou V, Korbonits M, Ackland GL. Redefining the perioperative stress response: a narrative review. Br J Anaesth. 2019;123(5):570–83.
Chen Y-YK, Soens MA, Kovacheva VP. Less stress, better success: a scoping review on the effects of anxiety on anesthetic and analgesic consumption. J Anesth. 2022;36(4):532–53.
Kil HK, Kim WO, Chung WY, Kim GH, Seo H, Hong JY. Preoperative anxiety and pain sensitivity are independent predictors of propofol and sevoflurane requirements in general anaesthesia. Br J Anaesth. 2012;108(1):119–25.
Ralph N, Norris P. Current opinion about surgery-related fear and anxiety. J Perioper Nurs. 2018;31(4):3–6.

No competing interests reported.

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published 08 Jun, 2023

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Editorial decision: Major revision
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The Relationship Between Fear of Surgery and Affecting Factors in Surgical Patients

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