Marital status rather than biological sex independently predicts preoperative anxiety among adults undergoing elective surgery: a cross-sectional APAIS study from western India

Preoperative anxiety significantly impacts perioperative outcomes through neuroendocrine activation, increased anaesthetic requirements, and impaired recovery. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a brief six-item screening instrument developed and validated in Dutch and subsequently in English. This study aimed to determine preoperative anxiety prevalence and identify associated demographic and clinical predictors among adult patients scheduled for elective surgery using the APAIS. This cross-sectional study was conducted at a tertiary care hospital in Western India (July 2023–June 2024). One hundred adults scheduled for elective surgery were recruited by systematic random sampling. The six-item APAIS was administered in its original English form; where a participant was not fully comfortable in English, a bilingual investigator gave an ad hoc, unscripted verbal explanation of each item in Hindi or Gujarati. Clinically significant anxiety was defined as an anxiety subscale score > 11. Analyses used t-tests, ANOVA, chi-square tests, correlations and multiple linear and logistic regression in R 4.5.2; the Benjamini–Hochberg false discovery rate (FDR) correction was applied separately within two pre-defined test families (mean anxiety score; high-anxiety prevalence). Clinically significant anxiety prevalence was 48% (95% CI: 38.1–57.9%). Mean anxiety subscale score was 11.63 ± 3.23; Cronbach α = 0.806. In bivariate analysis, unmarried status (Cohen d = 1.33), younger age ( r = − 0.43) and oncological surgery (η²=0.30) remained associated with higher anxiety after FDR correction (all q < 0.001); a weaker association with higher education (η²=0.11, uncorrected p = 0.031) did not survive correction (q = 0.056). Surgery-related anxiety exceeded anaesthesia-related anxiety (d = 0.68, p < 0.001). In multivariable linear regression, only unmarried status was an independent predictor (B = 2.90, 95% CI: 1.09–4.72, p = 0.002); the corresponding logistic odds ratio, 3.90 (95% CI: 0.92–16.58), did not reach significance ( p = 0.066), and an exploratory parsimonious model gave 4.26 (95% CI: 1.05–17.19, p = 0.042). Nearly half of elective surgery patients experienced clinically significant anxiety, with unmarried status the strongest and most consistent predictor, whereas biological sex was not. Brief preoperative anxiety screening may help identify patients who would benefit from targeted psychological support, but routine use of the APAIS here should await formal Hindi and Gujarati translation and validation. The single-centre design and modest sample size warrant cautious interpretation and external validation.