Impact of Preoperative Sleep Quality and Anxiety on Postoperative Outcomes in Abdominal Gynecologic Cancer Surgery

This prospective observational study was conducted between February and May 2025 at a tertiary gynecologic oncology center. The aim was to evaluate the association between preoperative sleep quality and anxiety levels with postoperative outcomes in patients undergoing open abdominal surgery for gynecologic cancer.

Eligible participants were women aged 18 years or older who were scheduled for elective laparotomy with general anesthesia. Patients with psychiatric disorders, major neurological conditions, or incomplete postoperative data were excluded.

Sleep quality was assessed preoperatively using the Pittsburgh Sleep Quality Index (PSQI), and anxiety was measured using the Beck Anxiety Inventory (BAI). Patients with a PSQI score ≥5 were classified as having poor sleep quality, and those with BAI scores ≥16 were classified as having high anxiety.

Postoperative pain was evaluated using the Numeric Rating Scale (NRS) at 0, 4, 8, 12, and 24 hours after surgery. Additional analgesic requirements, early postoperative complications (e.g., surgical site infection, ileus, nausea-vomiting, atelectasis), and length of hospital stay were recorded.

The study also examined potential psychosocial contributors such as mobile phone use during sleep, internet-based health information seeking, and patients' satisfaction with preoperative counseling using a structured Likert scale.

All data were collected via face-to-face interviews and hospital records. Statistical analyses included Mann-Whitney U test, chi-square test, and Spearman correlation coefficients. The study was approved by the Institutional Ethics Committee (Approval No: 2025/38), and all participants provided written informed consent.

Inclusion criteria

• Female patients aged ≥18 years
• Diagnosed with gynecologic malignancy
• Scheduled for elective abdominal surgery (laparotomy)
• Able to provide informed consent
• Completed preoperative sleep and anxiety assessments

Exclusion criteria

• History of psychiatric or cognitive disorders interfering with questionnaire participation
• Emergency surgical procedures
• Incomplete follow-up data within 30 days postoperatively
• Patients admitted for inpatient observation prior to surgery
• Major previous pelvic surgery