Optimizing Perioperative Risk: Understanding the Role of Preoperative Stress in Surgical Outcomes

Higher preoperative stressor counts predict longer hospital stays, greater postoperative pain, and increased delirium risk in older adults — highlighting the potential value of pragmatic preoperative screening to identify higher-risk patients.

In a cohort analysis of older adults undergoing surgery, the preoperative stress study found that accumulating stressors were associated with longer lengths of stay, greater postoperative pain, and higher delirium rates. The study links an endpoint cluster—longer LOS, increased pain, and elevated delirium risk—as its principal finding in an older surgical cohort.

Common preoperative stressors included major life events, caregiving strain, financial worries, anxiety, functional decline, social isolation, and changes in sleep or appetite. These stressors likely reduce baseline coping, amplify pain perception, fragment sleep, and raise delirium vulnerability—thereby connecting psychosocial burden to established perioperative pathways and highlighting modifiable risk domains.

Brief, structured pre-op screening identified patients at elevated risk. Feasible options that fit usual preoperative workflows include a one- to three-item stressor count, a single-question distress screen, or a short psychosocial checklist embedded in nursing or anesthesia assessments. Identified patients can be routed to expedited geriatric or psychiatric consults, focused pain-prehabilitation education, brief behavioral therapy or coping-skills coaching, and social work support.

Key Takeaways:

• Higher preoperative stressor counts predict longer hospital stays, greater postoperative pain, and higher delirium risk in older surgical patients.
• Older adults with accumulated psychosocial stressors—such as major life events, caregiving strain, or financial and functional concerns—face disproportionate postoperative risk.
• Embed brief stressor screening into preoperative assessment and create streamlined referral pathways for targeted optimization.