Original Research The prevalence of postoperative pain and its association with preoperative anxiety: A cross-sectional study at a tertiary hospital in Johannesburg, South Africa

Amma A. Antwi, Nana-Yaa Fening, Brian Gardner

About the author(s) Amma A. Antwi, Department of Anaesthesia, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; and Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
Nana-Yaa Fening, Department of Anaesthesia, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; and Charlotte Maxeke Academic Hospital, Johannesburg, South Africa
Brian Gardner, Department of Anaesthesia, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa; and Colleges of Medicine of South Africa (CMSA), Johannesburg, South Africa

Abstract

Background: Postoperative pain (POP) significantly affects patient recovery and well-being, with preoperative anxiety being a potential contributor to its development and severity.
Aim: The primary aim of this study was to investigate the prevalence of POP and secondarily to explore the association between preoperative anxiety and POP in patients undergoing orthopaedic and general surgical procedures.
Setting: A tertiary hospital in Johannesburg, South Africa.
Methods: This was a cross-sectional study, which enrolled 105 adults undergoing elective orthopaedic or general surgery. Preoperative anxiety was measured before surgery using the Amsterdam Preoperative Anxiety and Information Scale (APAIS), and POP was assessed once within 12 h – 24 h after surgery using the Numeric Pain Rating Scale (NPRS).
Results: Preoperative anxiety was present in 24.8% of patients and was associated with female sex (odds ration [OR]: 2.63, 95% confidence interval [CI]: 1.06–6.50) and high need for information (OR: 8.43, 95% CI: 3.08–23.04). Post-surgery, 65.7% reported experiencing moderate-to-severe pain at the time of interview, with orthopaedic surgery strongly associated with higher pain (OR: 5.19, 95% CI: 2.17–12.46). No significant association was found between preoperative anxiety and POP (adjusted OR [aOR]: 1.65, 95% CI: 0.57–4.77), although a weak correlation was observed for procedure-specific anxiety (ρ = 0.21, p = 0.036).
Conclusion: Postoperative pain remains a significant challenge in the study setting, with a high prevalence of moderate-to-severe pain, highlighting persistent gaps in pain management.
Contribution: This finding is consistent with studies in Africa and globally. Although preoperative anxiety prevalence was lower than global estimates from meta-analyses, our results aligned with a similar local study, possibly reflecting contextual factors. No association was observed between preoperative anxiety and POP. However, as the study was not powered for definitive conclusions, these findings should be interpreted as exploratory.

Keywords

pain; postoperative; anxiety; preoperative care; developing countries; Amsterdam Preoperative Anxiety and Information Scale; Numeric Pain Rating Scale

Sustainable Development Goal

Goal 3: Good health and well-being

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