Background <p>Preoperative anxiety adversely affects anesthetic management, hemodynamic stability, and recovery. Among modifiable perioperative variables, the impact of preoperative waiting time on anxiety and postoperative outcomes has been insufficiently explored.</p> Aim <p>To assess the relationship between waiting time and perioperative anxiety, hemodynamic responses, intraoperative opioid use, and postoperative analgesic requirements in adults undergoing elective surgery under general anesthesia.</p> Methods <p>In this prospective observational study, 130 ASA I–II adults were evaluated in the preoperative waiting area. The Amsterdam Preoperative Anxiety and Information Scale (APAIS), systolic blood pressure, and heart rate were measured on arrival and immediately pre-induction<b>.</b> Waiting time was the interval between these assessments. Intraoperative fentanyl/remifentanil doses and postoperative tramadol consumption were recorded. Pearson correlation and linear regression were used (<i>p</i> &lt; 0.05).</p> Results <p>Longer waiting times were associated with higher pre-induction APAIS scores (<i>r</i> = 0.339, <i>p</i> &lt; 0.001) and greater postoperative tramadol use (<i>r</i> = 0.333, <i>p</i> &lt; 0.001). Waiting time inversely correlated with preoperative systolic blood pressure (<i>r</i> =  − 0.253, <i>p</i> = 0.004). Associations with intraoperative opioid doses were not significant. Female sex, lower education, prior surgery, and negative surgical experiences were associated with higher anxiety. Midazolam premedication did not prevent anxiety escalation in patients with extended waiting times.</p> Conclusion <p>Preoperative waiting time is a modifiable, hospital-based factor that meaningfully influences perioperative anxiety and postoperative analgesic demand. Reducing unnecessary delays through individualized perioperative planning may enhance patient comfort, support hemodynamic stability, and reduce postoperative analgesic requirements.</p>