Incidence, Associated Risk Factors, and Outcomes of Postoperative Anxiety in Elderly: A Retrospective Observational Study

Hao Guo; Li-Heng Li; Xiao-Hong Lv; Fei Xiao; Yu-Bo Xie

doi:10.1002/hsr2.71682

Incidence, Associated Risk Factors, and Outcomes of Postoperative Anxiety in Elderly: A Retrospective Observational Study

Health Sci Rep. 2026 Jan 11;9(1):e71682. doi: 10.1002/hsr2.71682. eCollection 2026 Jan.

Authors

Hao Guo¹, Li-Heng Li², Xiao-Hong Lv³, Fei Xiao⁴, Yu-Bo Xie^{1

5}

Affiliations

¹ Department of Anesthesiology, Renmin Hospital Hubei University of Medicine Shiyan Hubei China.
² Department of Anesthesiology The First Affiliated Hospital of Guangxi Medical University Nanning Guangxi China.
³ Department of Anesthesiology, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences Cancer Hospital Affiliated to Shanxi Medical University Taiyuan Shanxi China.
⁴ Department of Anesthesiology, Beijing Anzhen Hospital Capital Medical University Beijing China.
⁵ Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center University of Electronic Science and Technology of China Chengdu Sichuan China.

Abstract

Background and aims: Postoperative anxiety (POA) is a frequently underrecognized complication in elderly surgical patients, with potential impacts on recovery and long-term mental health. This study aimed to investigate the incidence of POA, identify associated risk factors, and evaluate its short-term consequences in elderly individuals undergoing surgery.

Methods: A retrospective observational study was conducted among patients aged 65 years and older who underwent elective surgery under general anesthesia between May 2020 and March 2021. Anxiety was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale at baseline and during the first 7 days postoperatively. Postoperative pain, sleep quality, and other clinical outcomes were evaluated. Multivariable logistic regression identified independent risk factors for POA, and subgroup analyses were performed based on gender, frailty status, and surgery type. Missing data were handled using multiple imputation.

Results: Among 308 eligible patients, 51.9% developed POA within 7 days post-surgery. The highest incidence occurred after orthopedic (64.6%) and urologic (60%) procedures. POA was significantly associated with worse postoperative pain (higher NRS scores, increased use of rescue analgesia) and poorer sleep quality on postoperative days 1-3. Multivariable analysis revealed that preoperative anxiety (OR, 3.60; 95% CI, 1.76-7.40) and preoperative sleep disturbance (OR, 3.34; 95% CI, 1.82-6.13) were identified as independent risk factors of POA. Anxiety at 30 and 90 days after surgery was significantly increased compared with those without POA (26% vs 15% and 22% vs 12%, respectively).

Conclusion: POA is prevalent in elderly surgical patients and is associated with worse early postoperative outcomes. Screening for anxiety and sleep disturbances before surgery may help identify high-risk individuals. Early psychological or sleep-focused interventions could improve recovery and prevent persistent anxiety symptoms.

Keywords: anxiety; elderly; general anesthesia; pain; sleep quality.