Anesthesiology · 2025
Mixed-methods Analysis of Preoperative Distress and Postoperative Outcomes in a Prospective, Observational Cohort of Older Adults.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Kjaerulff Isabella, Soyster Heinz Sloan A, Fuller Matthew, Wright Mary Cooter, Blitz Jeanna, Browndyke Jeffrey, Mathew Joseph P, Whitson Heather, Acker Leah C
Аннотация
BACKGROUND: The effect of psychological distress on general geriatric surgery outcomes remains unexplored despite recommendations for routine, preoperative distress screening. This study 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 nonintracranial, noncardiac surgery patients aged 65 yr and older evaluated three preoperative distress measures using a slightly modified National Comprehensive Cancer Network Distress Thermometer: (1) overall distress intensity (0 to 10 rating); (2) stressor count (number of stressors selected from a prespecified checklist); and (3) distress themes (qualitative free-text analysis). Participants underwent morning and evening delirium evaluation for 3 postoperative days using the 3-min Confusion Assessment Method. Additional postoperative outcomes were extracted from the medical record.
RESULTS: Of 132 participants (mean age, 71.8 ± 5.1 yr; 50.0% female), 129 engaged in distress assessment; 42.2% reported high distress intensity (greater than or equal to 4 of 10). The median [quartile 1, quartile 3] stressor count was 2 [1, 5]. Stressor count-but not distress intensity-was associated with postoperative hospital length-of-stay (Spearman's r s [95% CI], 0.24 [0.06 to 0.40]; P = 0.017), postoperative pain (r s [95% CI], 0.25 [0.07 to 0.41]; P = 0.016), and risk for postoperative delirium (odds ratio [95% CI], 1.19 [1.06 to 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, the 2.5-min, modified National Comprehensive Cancer Network Distress Thermometer provides patient-specific information that may allow anesthesiologists to offer targeted stress interventions, bedside relaxation techniques, or simply preoperative discussions tailored to each patient's greatest concerns.
METHODS: This secondary analysis of 132 volunteers in a single-center, prospective cohort of nonintracranial, noncardiac surgery patients aged 65 yr and older evaluated three preoperative distress measures using a slightly modified National Comprehensive Cancer Network Distress Thermometer: (1) overall distress intensity (0 to 10 rating); (2) stressor count (number of stressors selected from a prespecified checklist); and (3) distress themes (qualitative free-text analysis). Participants underwent morning and evening delirium evaluation for 3 postoperative days using the 3-min Confusion Assessment Method. Additional postoperative outcomes were extracted from the medical record.
RESULTS: Of 132 participants (mean age, 71.8 ± 5.1 yr; 50.0% female), 129 engaged in distress assessment; 42.2% reported high distress intensity (greater than or equal to 4 of 10). The median [quartile 1, quartile 3] stressor count was 2 [1, 5]. Stressor count-but not distress intensity-was associated with postoperative hospital length-of-stay (Spearman's r s [95% CI], 0.24 [0.06 to 0.40]; P = 0.017), postoperative pain (r s [95% CI], 0.25 [0.07 to 0.41]; P = 0.016), and risk for postoperative delirium (odds ratio [95% CI], 1.19 [1.06 to 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, the 2.5-min, modified National Comprehensive Cancer Network Distress Thermometer provides patient-specific information that may allow anesthesiologists to offer targeted stress interventions, bedside relaxation techniques, or simply preoperative discussions tailored to each patient's greatest concerns.