Authors: Kjaerulff, Isabella et al.
Anesthesiology October 2025 | DOI: 10.1097/ALN.0000000000005780
This prospective mixed-methods study explored the relationship between preoperative psychological distress and postoperative outcomes in older adults undergoing noncardiac, nonneurosurgical procedures. Despite growing recognition that emotional well-being influences recovery, routine distress screening has not yet been integrated into most preoperative assessments.
A total of 132 patients aged 65 years or older (mean 71.8 ± 5.1 years; 50% female) were enrolled from a single-center geriatric surgery cohort. Participants completed a modified National Comprehensive Cancer Network Distress Thermometer (NCCN-DT), evaluating: (1) distress intensity (0–10 scale), (2) number of stressors selected from a checklist (“stressor count”), and (3) qualitative free-text distress themes. Postoperative delirium was assessed twice daily for three days using the 3-Minute Confusion Assessment Method, while pain scores and length of stay were extracted from the medical record.
Nearly half (42.2%) reported moderate-to-severe distress (≥ 4/10). The median stressor count was 2 [1–5]. Importantly, stressor count—but not distress intensity—was significantly correlated with longer hospital stays (Spearman’s rₛ = 0.24, P = 0.017), higher postoperative pain (rₛ = 0.25, P = 0.016), and greater risk of postoperative delirium (OR 1.19 per additional stressor, P = 0.009). Commonly cited stressors included difficulties with eating, communication barriers with staff, poor sleep, and anxiety—each potentially modifiable through targeted interventions.
The study demonstrates that a brief, structured distress screening tool can reveal modifiable psychosocial risk factors before surgery. Preoperative attention to patient-reported stressors may enable tailored interventions—ranging from relaxation techniques to enhanced perioperative communication—that could improve recovery trajectories in geriatric surgical patients.
What You Should Know
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Over 40% of older surgical patients report significant preoperative distress.
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The number of identified stressors (not the distress rating alone) predicts higher postoperative pain, delirium, and longer hospital stays.
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A quick 2.5-minute distress screening may allow anesthesiologists to address psychosocial risks before surgery, improving recovery and satisfaction.
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