Anesthesia-related fear in adult surgical patients: prevalence, severity, and predictors in a multicenter cross-sectional study

Anesthesia-related fear (ARF) is a clinically meaningful but poorly understood issue that can affect how patients do before, during, and after surgery. Unlike general anxiety, ARF is tied directly to anesthesia itself—what patients think might happen to them when they are put to sleep or numbed. This study looked at how common ARF is among adults having elective surgery in Iran and what factors predict it. Between December 2023 and February 2024, we conducted a cross-sectional study at two teaching hospitals in Tehran (Modarres and Imam Hossein). We enrolled 426 patients aged 18 or older who were scheduled for elective surgery. ARF was measured using a 15-item questionnaire adapted for Persian speakers, with scores from 15 to 75 (theoretical range) and a five-point Likert scale. The questionnaire had good internal consistency (Cronbach’s α = 0.88) and, through exploratory factor analysis, revealed three distinct fear components. Psychological vulnerability was captured using the Persian version of the GAD-7. For analysis, ARF scores were grouped into low (15–24), moderate (25–32), and high (33–75) based on how scores were actually distributed in our sample. We used ordinal logistic regression to find independent predictors, checking the proportional odds assumption with the Brant test. Of 550 patients approached, 426 completed the study (response rate 90.7%). The average age was 45.3 ± 15.2 years; 54.7% were female. Mean ARF score was 29.0 ± 12.7 (observed range 15–72). Severity broke down as: low 23.9% ( n = 102), moderate 51.4% ( n = 219), and high 24.6% ( n = 105). Mean GAD-7 score was 8.1 ± 4.5 and rose consistently across ARF groups (5.8 → 8.1 → 11.2; p < 0.001). Fears of stroke (37.3%) and cardiac arrest (31.5%) during anesthesia were the most common. In multivariable analysis, higher ARF severity was independently associated with higher GAD-7 score (OR = 1.14 per point; 95% CI: 1.10–1.19; p < 0.001), ASA III/IV status (OR = 1.88; 95% CI: 1.10–3.20; p = 0.021), female sex (OR = 1.67; 95% CI: 1.08–2.58; p = 0.020), and younger age (OR = 0.98 per year; 95% CI: 0.97–0.99; p = 0.001). The model fit well (Brant test p = 0.671; Nagelkerke’s pseudo-R² = 0.285). ARF is common among Iranian surgical patients. Higher anxiety scores, poorer physical status, being female, and being younger all independently predicted more severe fear. Since our cut-points were derived from this sample’s score distribution, they shouldn’t be treated as fixed clinical thresholds. Future work should focus on validating the ARF instrument against established anxiety scales.