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Background: Evaluating preoperative anxiety level can be a difficult task for physicians. The Visual Facial Anxiety Scale (VFAS) was designed as an alternative to the Verbal Rating Scale (VRS) for assessing the level of preoperative [state] anxiety. We hypothesized that the VFAS would provide a stronger correlation between the patient and anesthesiologist categorical anxiety assessments than the VRS.  

Methods: After obtaining IRB approval, 200 elective surgery patients were evaluated in the preoperative holding area. Patients were asked to evaluate their current anxiety level using the VFAS and the VRS, as well as to categorize their anxiety level as mild, moderate, or severe. The anxiety level was also assessed using the same categorical rating scale by the attending anesthesiologist. The anesthesiologists were also asked if they routinely evaluate the patient’s anxiety level during the preoperative visit.

 Results: A significant correlation was found between the VRS and VFAS for both patients (r=0.79, p<0.0001) and anesthesiologists (r=0.92, p<0.0001), but utilization of the VFAS resulted in 58% concordance of anxiety level between the patient and anesthesiologist (vs. only 35% with the VRS). Interestingly, 70% of anesthesiologists did not routinely evaluate the patients’ preoperative anxiety level.  

Conclusion: The VFAS is a simple tool which could be used for assessing preoperative anxiety. Anesthesiologists do not routinely evaluate patients’ anxiety levels preoperatively.