Preoperative Surgical Fear and Association with Postoperative Pain and Quality of Recovery After Total Joint Arthroplasty

Background: Recovery following total joint arthroplasty varies substantially among patients, and psychological factors may partly account for this variability. Although anxiety and depression have been widely investigated, the specific contribution of preoperative surgical fear to postoperative pain and quality of recovery remains unclear. This study aimed to examine the association between preoperative surgical fear and postoperative pain intensity and quality of recovery. Methods: This prospective, hospital-based observational study enrolled 89 patients undergoing primary total knee or hip arthroplasty. Preoperative surgical fear was measured using the Surgical Fear Questionnaire (SFQ). Pain intensity was assessed with the Numeric Rating Scale (NRS) preoperatively and at three postoperative time points. Recovery quality at 24 h was evaluated using the Quality of Recovery-40 (QoR-40). Pearson correlation and multiple linear regression analyses were performed to evaluate associations and identify variables independently associated with recovery outcomes, controlling for potential confounders, including age, sex, ASA physical status, and type of surgery. Results: The mean SFQ score was 26.62 ± 15.19, and the mean QoR-40 score was 157.63 ± 16.66. Surgical fear was moderately and negatively correlated with overall recovery quality (r = −0.546, p < 0.001). In multiple linear regression analysis, surgical fear was most strongly associated with poorer overall recovery quality (β = −0.563, p < 0.001), within a model explaining 30.3% of the variance (adjusted R2 = 0.303). At the subscale level, surgical fear was significantly associated with emotional state, pain, physical comfort, and perceived support. Pain intensity at 12 h postoperatively was significantly associated with reduced physical independence (β = −0.218, p = 0.038). Pain intensity peaked at 12 h postoperatively (p < 0.001). Conclusions: Higher levels of preoperative surgical fear are associated with poorer quality of recovery following total joint arthroplasty. These findings highlight surgical fear as a potentially relevant perioperative factor and support the integration of routine psychological assessment into perioperative care pathways in relation to early postoperative recovery outcomes. From a clinical perspective, early identification of patients with high surgical fear may facilitate targeted perioperative counseling and supportive interventions by healthcare professionals, potentially improving recovery outcomes.