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. 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.