For older adults facing major surgery, what predicts a rocky recovery may be not how intensely worried they feel, but how many worries they carry. A Duke Health team led by anaesthesiologist Leah Acker reports in the journal Anesthesiology that the sheer count of preoperative stressors, from sleep and appetite changes to caregiving duties and fear of losing independence, predicted delirium, pain and longer hospital stays.
The study enrolled 132 patients aged 65 and over undergoing major surgery, excluding heart and brain operations, between November 2022 and December 2024. Using a three-minute tablet-based distress screen, a 39-item concern checklist and open-ended responses, the researchers found that more than four in ten patients reported moderate to high distress before their operations, a level comparable to that seen in patients with advanced cancer.
The odds of postoperative delirium rose with each additional stressor, and patients who developed delirium reported a median distress intensity of 3.5 on a ten-point scale, against 2 for those who did not. The authors describe an overwhelmed phenotype in which small stressors accumulate and hinder recovery, and argue that a brief routine screen before surgery could flag at-risk patients for simple, targeted support.