Mixed-Methods Analysis of Preoperative Distress and Postoperative Outcomes in a Prospective, Observational Cohort of Older Adults

Background: The effect of psychological distress on general geriatric surgery outcomes remains unexplored despite recommendations for routine, preoperative distress screening. We aimed to assess preoperative distress measures in a general geriatric surgery cohort, and evaluate associations with postoperative outcomes, including delirium, pain, and length of stay.

Methods: This secondary analysis of 132 volunteers in a single-center, prospective cohort of non-intracranial, non-cardiac surgery patients aged ≥ 65 evaluated 3 preoperative distress measures using a slightly modified National Comprehensive Cancer Network Distress Thermometer (NCCN-DT): 1) overall “distress intensity” (0-10 rating), 2) “stressor count” (number of stressors selected from a pre-specified checklist), and 3) “distress themes” (qualitative free-text analysis). Participants underwent morning and evening delirium evaluation for three postoperative days using the 3-minute Confusion Assessment Method. Additional postoperative outcomes were extracted from the medical record.

Results: Of 132 participants (mean age: 71.8 ± 5.1, 50.0% female), 129 engaged in distress assessment; 42.2% reported high distress intensity (≥ 4/10). Median [Q1, Q3] stressor count was 2 [1, 5]. Stressor count-but not distress intensity-was associated with postoperative hospital length-of-stay (Spearman’s rs [95% CI]: 0.24 [0.06,0.40]; p=0.017), postoperative pain (rs [95% CI]: 0.25 [0.07,0.41]; p=0.016), and risk for postoperative delirium (OR [95% CI]: 1.19 [1.06,1.33]; p=0.009, univariable analysis). Stressors most associated with high distress- “changes in eating,” “communication with the healthcare team,” “sleep,” and “worry or anxiety”-are potentially addressable.

Conclusions: Psychological distress is common among geriatric surgery patients, and higher preoperative stressor count was associated with worse postoperative outcomes. While larger validation studies are needed, our 2.5-minute, modified NCCN-DT provides patient-specific information, which may allow anesthesiologists to offer targeted stress interventions, bedside relaxation techniques, or simply preoperative discussions tailored to each patient’s greatest concerns.