Published online Jul 19, 2026. doi: 10.5498/wjp.118506
Revised: March 5, 2026
Accepted: March 31, 2026
Published online: July 19, 2026
Processing time: 142 Days and 10.3 Hours
Preoperative anxiety is prevalent among surgical patients and may adversely affect postoperative outcomes. However, evidence of its specific impact on pati
To investigate the relationship between preoperative anxiety levels and postop
A total of 300 consecutive patients scheduled for thyroidectomy were enrolled between January 2024 and December 2024. Preoperative anxiety was assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A), with patients categorized into low anxiety (HADS-A ≤ 7, n = 168) and high anxiety (HADS-A > 7, n = 132) groups. Primary outcomes included postoperative pain intensity measured using the Visual Analog Scale (VAS) at 24 hours, 48 hours, and 72 hours, and recovery quality assessed using the Quality of Recovery-40 (QoR-40) questionnaire. Secondary outcomes included lower extremity deep vein thrombosis (DVT), neck muscle stiffness evaluated using the Neck Disability Index (NDI), scar healing quality assessed using the Patient and Observer Scar Assessment Scale (POSAS), postoperative hospital stay, and central compartment lymph node metastasis rate.
High anxiety patients demonstrated significantly higher VAS pain scores at 24 hours (4.82 ± 1.56 vs 3.21 ± 1.34, P < 0.001), 48 hours (3.67 ± 1.42 vs 2.45 ± 1.18, P < 0.001), and 72 hours (2.54 ± 1.23 vs 1.68 ± 0.95, P < 0.001) compared to low anxiety patients. QoR-40 scores were significantly lower in the high anxiety group at postoperative day 3 (142.36 ± 18.45 vs 165.82 ± 15.67, P < 0.001). The incidence of lower extremity DVT was significantly higher in the high anxiety group (6.82% vs 1.79%, P = 0.024). High anxiety patients exhibited greater neck muscle stiffness (NDI: 28.45 ± 8.67 vs 18.32 ± 6.54, P < 0.001) and poorer scar healing outcomes (POSAS: 32.56 ± 7.89 vs 24.67 ± 6.45, P < 0.001) at one-month follow-up. Postoperative hospital stay was prolonged in the high anxiety group (3.45 ± 1.12 days vs 2.67 ± 0.89 days, P < 0.001). No significant difference was observed in the central compartment lymph node metastasis rate between the groups (38.64% vs 41.07%, P = 0.667).
Preoperative anxiety significantly affects postoperative pain perception, recovery quality, DVT occurrence, neck muscle stiffness, scar healing, and postoperative hospital stay in patients undergoing thyroidectomy. These findings underscore the importance of preoperative psychological assessments and anxiety-targeted interventions for optimizing surgical outcomes.
Core Tip: This prospective study demonstrated that preoperative anxiety is not merely a psychological state but also a clinically meaningful predictor of postoperative outcomes in patients undergoing thyroidectomy. Higher anxiety levels were associated with significantly greater postoperative pain, poorer short-term recovery quality, increased risk of lower extremity deep vein thrombosis, greater neck muscle stiffness, worse scar healing, and longer hospital stays, while oncological outcomes were unaffected. These findings highlight the necessity of incorporating routine psychological screening and targeted perioperative anxiety management into thyroid surgery care pathways to improve patient-centered outcomes, enhance recovery efficiency, and reduce the burden of complications.