Authors: Kjaerulff, Isabella et al.
Anesthesiology, October 3, 2025. DOI: 10.1097/ALN.0000000000005780
This secondary analysis of a prospective cohort explored how preoperative psychological distress affects postoperative outcomes in older surgical patients. The study enrolled 132 adults aged 65 or older undergoing noncardiac, non-intracranial surgery. Distress was measured preoperatively using a modified National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), capturing three domains: distress intensity (0–10 scale), stressor count (number of selected stressors), and distress themes (qualitative free-text). Outcomes included delirium (assessed twice daily for three postoperative days), pain, and length of stay.
Of 129 patients who completed distress assessment, 42.2% reported high distress intensity (≥4/10). Median stressor count was 2 [1–5]. Importantly, stressor count—not intensity—was associated with worse outcomes: longer hospital stays (rs=0.24, p=0.017), more postoperative pain (rs=0.25, p=0.016), and higher risk of delirium (OR=1.19, 95% CI: 1.06–1.33, p=0.009). Stressors most linked with high distress included changes in eating, communication issues with healthcare providers, sleep difficulties, and anxiety—factors that may be modifiable.
The findings suggest that simple preoperative distress screening, particularly stressor count, can provide actionable insights into surgical risk in older adults. By identifying and addressing specific concerns, anesthesiologists may improve postoperative recovery through targeted interventions or supportive communication.
What You Should Know:
In older adults, preoperative stressors—not just distress intensity—predict adverse postoperative outcomes such as delirium, increased pain, and prolonged hospitalization. A brief screening tool like the NCCN-DT could enable anesthesiologists to intervene early with tailored support strategies.
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