The Association Between Preoperative Anxiety and Pain Severity, Opioid Requirement, Neutrophil-to-Lymphocyte Ratio, and Postoperative Blood Glucose After Gynecologic Laparotomy at Ngoerah Hospital

Fivilia Anjelina Bora (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)
Dewa Ayu Mas Shintya Dewi (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)
I Putu Kurniyanta (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)
Tjokorda Gde Agung Senapathi (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)
I Made Gede Widnyana (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana Un)
Putu Pramana Suarjaya (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)
I Gusti Ngurah Mahaalit Aribawa (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)
Tjahya Aryasa EM (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)
Pontisomaya Parami (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)
Otniel Andrians Labobar (Department of Anesthesiology and Intensive Care Therapy, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia)

Medicinus : Jurnal Kedokteran
Vol. 15 No. 2 (2026): February

Background: We assessed whether preoperative anxiety is associated with postoperative pain severity, opioid requirement, neutrophil-to-lymphocyte ratio (NLR), and blood glucose after gynecologic laparotomy. Methods: Prospective cohort at Ngoerah Hospital (May to June 2025). Anxiety was measured preoperatively with APAIS and categorized as non-anxious, mild, moderate, or severe. Outcomes were NRS pain at 6, 12, and 24 hours, total fentanyl in the first 24 hours, and NLR and blood glucose at 6 hours postoperatively. Multivariable analysis used MANCOVA (99% confidence intervals). Result: Fifty-four patients were included (mean age 41.78 ± 10.58 years). Anxiety distribution was 46.3% non-anxious, 25.9% mild, 24.1% moderate, and 3.7% severe. Higher anxiety was associated with higher NRS at 6 hours (B 0.842; 99% CI 0.475 to 1.209; p < 0.001), 12 hours (B 0.381; 0.247 to 0.515; p < 0.001), and 24 hours (B 0.158; 0.048 to 0.269; p = 0.048). Anxiety was associated with higher 24-hour fentanyl requirement (B 147.8 microg; 99% CI 124.062 to 171.651; p < 0.001), higher postoperative NLR (B 4.31; 99% CI 0.609 to 8.027; p = 0.024), and higher postoperative blood glucose (B 19.4 mg/dL; 99% CI 7.912 to 30.912; p = 0.001). Conclusions: Higher preoperative anxiety was independently associated with worse pain, greater opioid requirement, and higher postoperative NLR and blood glucose after gynecologic laparotomy.