The APAIS scale, for Amsterdam Preoperative Anxiety and Information Scale, is a brief questionnaire used in the context of a scheduled procedure. It helps to describe two different issues: anxiety related to anesthesia or the operation, and the need to obtain more information. Its French version has undergone published psychometric validation.
If you are looking for ways to ease anxiety before an operation, see anxiety before an operation: how to ease it.
Post-operative pain: A large part of the anxiety revolves around pain. Here's what 50,000 patients reported after their operation, without any predicted or promised results. Read the page.
The Apfel score. Another common concern before an operation: vomiting upon waking. The Apfel score estimates this in four questions. Open the score.
Fasting Reminder: One of the most tangible anxieties the night before is the time of the last meal. This fasting reminder lists the published durations, with the source for each, and allows you to note the time given by your team. Open the reminder.
This page explains the structure of the APAIS questionnaire and the calculation of its subscores. It does not offer an interactive test and does not reproduce the six complete French versions. A single score does not constitute a diagnosis and should not, on its own, determine the course of action to be taken before surgery.
What is the purpose of the APAIS scale?
The APAIS was designed to quickly gather information about a person's feelings before a procedure. It distinguishes between concerns about anesthesia, concerns about the surgical procedure itself, and a desire to know more. This distinction is important: a person can ask for many explanations without expressing the same level of concern, or feel worried despite having already received detailed information.
The French validation published in 2013 confirmed this three-dimensional structure. A previous French study had also compared the APAIS to a longer anxiety assessment instrument. This research supports the use of the scale as a brief data collection tool in the perioperative setting. It does not, however, transform its results into an individual judgment.
How are the six items organized?
The APAIS questionnaire comprises six statements. In the standard order of the scale, two items concern anxiety associated with anesthesia, two concern anxiety associated with the operation, and two explore the desire for information. Each response is rated on an ordinal scale from 1 to 5, from weak agreement to strong agreement.
- Items 1 and 2 make up the anesthesia-related anxiety subscore;
- Items 4 and 5 make up the subscore for anxiety related to the operation;
- Items 3 and 6 make up the information need subscore;
- The four anxiety items can be added together to obtain the overall preoperative anxiety index of the scale.
Accurate wording is crucial: an improvised paraphrase or a modified order does not automatically constitute the accepted version. For formal administration, the format chosen by the institution or professional must be used, along with the appropriate instructions and language version.
Calculation of the APAIS score and sub-scores
The calculation involves adding the values of the items belonging to each dimension. The total anxiety should not be confused with the information need, as they address different questions.
| Subscore | Calculation | Possible extent |
|---|---|---|
| Anxiety related to anesthesia | item 1 + item 2 | 2–10 |
| Anxiety related to the operation | item 4 + item 5 | 2–10 |
| Global preoperative anxiety | items 1 + 2 + 4 + 5 | 4–20 |
| Need information | item 3 + item 6 | 2–10 |
Adding the six responses together into a single number conflates anxiety and the need for information. This overall sum should therefore not replace the subscores described by the scale. If a value seems inconsistent, check the order of the items and the transcript before any discussion.
How can we read a result without overinterpreting it?
A higher score on a dimension indicates stronger agreement with the corresponding statements at the time the questionnaire is completed. It does not specify the cause of the concern, how long it has been present, or its impact on daily life. Context matters: time elapsed before the intervention, information already received, prior experience, the language in which the questionnaire is administered, and recent events can all influence the responses.
This page does not provide thresholds, rankings, or automatic conclusions. The thresholds reported in some publications are specific to particular objectives and populations. Applying them to an individual outside of this context would be misleadingly accurate. Clinical discussion remains essential to understand the underlying concerns and what information is missing.
Why is APAIS not a diagnosis?
The APAIS focuses on the preoperative period. It does not replace a medical or psychological consultation and is not sufficient to identify an anxiety disorder. Nor does it seek to identify all symptoms, their duration, their possible causes, or situations of acute distress.
Its practical value lies in making the conversation more precise. A subscore related to anesthesia prompts questions about which steps are causing concern. A strong need for information suggests checking explanations understood and any remaining questions. The French Society of Anesthesia and Intensive Care reminds us that the consultation allows us to ask relevant questions and express our preferences to the anesthesiologist.
When and with whom should we talk about it?
Bring your questions to the anesthesia consultation and discussions with the surgical team. Our article on pre-operative anxiety provides general guidelines to help you prepare for this discussion. The pre-operative preparation checklist helps you gather documents, medical history, and questions, as well as any hospital-specific instructions.
The Royal College of Anaesthetists indicates that various approaches to mental preparation can be offered and advises consulting the hospital team or general practitioner when additional support seems necessary. This is a point for discussion, not an answer automatically deduced from the score.
To understand the general order of the consultation, anesthesia, and follow-up, please also consult the guide to the surgical pathway in France . The documents provided by your hospital take priority, as they pertain to your procedure and its actual organization.
Prepare the questions to ask the team
This assistant is not part of the APAIS scale and does not calculate any scores. It simply transforms the themes you select into a list of general questions to bring to the consultation. Adapt these questions with the team familiar with your intervention.
FREE TOOL · PREPARE FOR THE CONSULTATION
Consultation preparation assistant
Confidentiality: No choices are sent or saved. The list exists only on the open page and does not replace a discussion with a professional. Only an anonymous audience measurement, if you have accepted it, indicates the use of the tool.
Limitations of a self-administered questionnaire
- the response describes a moment and may evolve as more information is received;
- Word comprehension and response scale may vary;
- A result alone does not reveal the precise reason for a concern;
- the version, the order of the items and the administration conditions must remain consistent;
- An emergency or distress should not be assessed solely by this questionnaire.
If anxiety is preventing you from understanding instructions, communicating with the team, or coping with daily life, report it directly to a professional. In case of immediate danger or acute distress, use the emergency services appropriate to your situation rather than an online self-assessment questionnaire.
FAQ about the APAIS scale
Is there a single APAIS score?
The scale distinguishes between anxiety and the need for information. The overall anxiety index is based on four items, while the need for information index is based on the other two. The six responses should not be interpreted in a single way.
Does this page contain the complete APAIS questionnaire?
No. It describes the structure and calculation without reproducing the formulas in full. A formal administration must use a validated version and the framework chosen by the professional or institution.
Is a high score enough to draw a conclusion?
No. It serves to document an exchange. Only a professional can put the answers into context, investigate their cause, and assess the person's needs.
Verified sources
- PubMed, PMID 21602018, French assessment of preoperative anxiety and the need for information with the APAIS.
- PubMed, PMID 24099176, validation of the French version of APAIS.
- SFAR, medical information on anesthesia and the role of the consultation.
- Royal College of Anaesthetists, mental preparation before an operation.
Editorial Notice: General information content prepared from the listed sources and editorially reviewed on July 16, 2026. No specific medical review is claimed. This page does not constitute a diagnosis and is not a substitute for consultation with the surgical team, anesthesiologist, or a mental health professional.
