Authors: Kjaerulff I. et al.
Anesthesiology, October 3, 2025. DOI: 10.1097/ALN.0000000000005780
This mixed-methods analysis explored how preoperative psychological distress influences postoperative outcomes in older surgical patients—a critical but underexamined aspect of perioperative care. Despite calls for routine distress screening in geriatric populations, evidence linking preoperative distress to clinical outcomes has been sparse.
The study analyzed data from 132 adults aged 65 years and older enrolled in a single-center, prospective cohort of patients undergoing elective noncardiac, nonintracranial surgery. Using a modified National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), researchers quantified distress across three domains: (1) overall distress intensity (0–10 scale), (2) stressor count (number of selected stressors from a predefined checklist), and (3) distress themes (qualitative free-text responses). Postoperative delirium was evaluated twice daily for three days using the 3-minute Confusion Assessment Method (3D-CAM), and pain and hospital length of stay were extracted from medical records.
Preoperative distress was prevalent—42% of patients reported a distress score ≥4/10. Importantly, stressor count, but not distress intensity, was significantly associated with multiple adverse postoperative outcomes:
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Longer hospital stay (Spearman’s rs = 0.24; P = 0.017)
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Higher postoperative pain (rs = 0.25; P = 0.016)
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Increased risk of postoperative delirium (OR 1.19 per additional stressor; P = 0.009)
Qualitative analysis identified the most common and modifiable stressors, including difficulties with eating, poor sleep, communication challenges with the healthcare team, and general anxiety or worry.
These findings demonstrate that assessing the number and nature of specific preoperative stressors—rather than relying solely on a numeric distress score—provides richer, actionable information for anesthesiologists and perioperative teams. Brief, structured preoperative distress screening could enable early interventions such as targeted counseling, relaxation techniques, or communication improvements that may mitigate postoperative complications in older adults.
What You Should Know
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Nearly half of older surgical patients experience moderate-to-high preoperative distress.
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The number of stressors (not just distress intensity) predicts higher postoperative pain, delirium, and longer hospitalization.
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Common stressors—poor sleep, appetite changes, anxiety, and communication issues—are potentially modifiable.
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A brief, 2.5-minute preoperative screening using the NCCN-DT can help tailor patient-centered interventions.
Thank you to Anesthesiology for publishing this insightful study highlighting the prognostic and practical value of preoperative distress assessment in geriatric surgical care.