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Background: Pre-operative anxiety is a common psychological state among patients undergoing high-risk surgeries, particularly abdominal surgeries. It is known to impact post-operative recovery outcomes significantly. It is associated with a higher risk of complications such as bleeding, infections and haemodynamic disturbances, while also affecting sleep quality and mental health. Aim: This study aimed to evaluate the levels of pre-operative anxiety in patients undergoing abdominal surgery and its impact on post-operative recovery and sleep quality. Methods and materials: A cross-sectional descriptive study was conducted in the Department of Gastrointestinal Surgery at a hospital in Vietnam, from September 2023 to August 2024. A sample of 150 patients was selected, and data were collected using standardised tools, including the Hospital anxiety and depression scale – anxiety subscale (HADS-A), the 15-item Quality of recovery scale (QoR-15) and the Verran and Snyder-Halpern (VSH) sleep scale. Results: Results indicated that 92 per cent of patients experienced varying degrees of anxiety before surgery, with a mean anxiety score of 7.0 ± 3.9. Pre-operative anxiety showed a significant negative correlation with both post-operative recovery quality (r = -0.896, p < 0.001) and sleep quality (r = -0.880, p < 0.001). The findings suggest that high levels of pre-operative anxiety negatively affect both recovery and sleep quality after abdominal surgery. Conclusion: This study emphasises the need for pre-operative psychological interventions to reduce anxiety and improve recovery. It highlights the vital role of perioperative nursing in routine anxiety screening and targeted counselling to support at-risk patients. Incorporating these practices can lessen anxiety and enhance post-operative recovery and sleep quality. Future research should assess the effectiveness of specific interventions and the long-term impact of anxiety on recovery.