Measuring preoperative anxiety in older surgical patients: an international Delphi study

Keywords:

Preoperative anxiety, older patients, Delphi study, content validation


Published online: Mar 18 2026

https://doi.org/10.56126/77.1.04

Yang K. L.1, Detroyer E.1,2, Islam F.3, Davis D.4, Alvarez-Garcia5, Boehm L.M.6, Bouckaert F.7, Dziadzko M.8, Ely E. W.9, Hardy A.10, Klimek M.11, Kowark A.12, Lambrichts S.13, Van Grootven B.1,3, Rex S.14,15, Milisen K.1,2

1 Department of Public Health and Primary Care, Academic Center for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
2 Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
3 Institute for Nursing Science, University of Basel, Basel, Switzerland
4 MRC Unit for Lifelong Health and Ageing Unit at UCL, London, United Kingdom
5 Department of Nursing, University of Jaén, Jaén, Spain
6 Critical illness, Brain Dysfunction, and Survivorship (CIBS) Center, School of Nursing, Vanderbilt University, Nashville, TN, USA
7 Geriatric Psychiatry, University Psychiatric Center KU Leuven and Leuven Brain Institute, Department of Neurosciences, Neuropsychiatry, Leuven, Belgium
8 Service d’Anesthésie, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, RESHAPE INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
9 Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
10 Clinique du Sport, Paris, France
11 Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
12 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
13 Department of Neurosciences, Research Group Psychiatry, KU Leuven, Leuven, Belgium
14 Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
15 Department of Cardiovascular Sciences, KU Leuven - University of Leuven, Leuven, Belgium

Abstract

Background: Preoperative anxiety is pervasive among surgical patients and associated with several complications, particularly in older patients. However, its assessment in older surgical patients remains challenging.

Objectives: To select the most appropriate instrument(s) for assessing preoperative anxiety in older surgical patients aged ≥65 years, assess their content validity, and reach consensus on a theoretical definition for preoperative anxiety.

Design and Setting: Three-round Delphi study.

Method: Experts in clinical management and/or research of (preoperative) anxiety, preoperative care, anaesthesiology, geriatrics, and psychiatry were included. Consensus required ≥70% agreement on instruments selection and their relevance, comprehensiveness and feasibility, and on definitions. The Content Validity Index (CVI) of each scale (S-CVI) and its items (I-CVI) were calculated for the selected instruments.

Results: Fourteen international experts participated in the study. The Surgical Anxiety Questionnaire (SAQ) was preferred for measuring preoperative anxiety in research settings, but not considered suitable for clinical practice. The Visual Analogue Scale-Anxiety (VAS-A) was preferred as the most appropriate instrument for measuring preoperative anxiety in clinical settings. The VAS-A had a higher S-CVI (0.92), while the SAQ had a lower S-CVI (0.74) with 10/17 items having I-CVI values below 0.78. Although the anxiety subscale of Amsterdam Preoperative Anxiety and Information Scale (APAIS-A) was highly recognized by the panel and had a high S-CVI score (0.91), it was not selected as the most appropriate for either research or clinical settings. Consensus was achieved regarding the theoretical definition of preoperative anxiety, emphasizing that preoperative anxiety is state anxiety.

Conclusions: This study provides a reference for enhancing preoperative anxiety management in older patients. Preoperative anxiety was defined as state anxiety, with VAS-A identified as the most appropriate instrument for clinical use, and SAQ preferred in research, although SAQ is a relatively new instrument that requires further validation.

Trial Registration: Not applicable.

ActaAnaesthBelg-77-1-cover

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Volume 77, issue 1.

Mar 2026.

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