Stress among older adults linked to worse surgery recovery

Even modest stress before surgery may influence how well older adults recover, according to a new study from Duke University School of Medicine.

The study, published in Anesthesiology, found that adults who carried more worries into the operating room faced higher risks of delirium, reported more uncontrolled pain, and spent additional days in the hospital — even if they did not view themselves as highly stressed.

Senior study author Leah C. Acker, MD, PhD, an anesthesiologist at Duke Health, said the findings highlight an overlooked opportunity to improve outcomes by identifying and addressing stress before surgery.

The study showed that more than 40% of older adults preparing for major surgery, but not heart or brain surgery, reported moderate to high distress — levels similar to those seen in patients with advanced cancer.

Surprisingly, it wasn’t how intense the stress felt, but the number of stressors. Stress count was strongly correlated with pain levels and hospital stays. The odds of experiencing delirium went up by 19% for each additional stressor.

Acker, an assistant professor of anesthesiology and neurobiology researcher, described this as an “overwhelmed phenotype,” where small pressures accumulate enough to hinder recovery.

“As the anesthesiologist, I have things I’m responsible for to keep a patient safe,” she said. “But patients have their own concerns too. The survey takes just minutes and gives us a window into what matters most to them, so we can tailor conversations or simple interventions that can make a difference.”  

To measure stress, researchers used a three‑minute digital version of the NCCN Distress Thermometer with 132 patients between November 2022 and February 2024.

Common concerns included changes in sleep or appetite, communication with health care providers, and family responsibilities. In an open-ended comment section, patients wrote in worries about finances, home repairs, losing their independence, the state of the country and keeping up with activities that bring them joy and meaning like traveling, concerts, and golf.

Because most adults over age 65 will undergo surgery at least once, Acker said doctors need better ways to spot who may be at risk for problems after surgery.

Delirium — a sudden state of confusion — is one of the most serious post‑operative complications for older adults, raising hospital costs and increasing the long‑term risk of dementia.

A larger study, she noted, could determine which specific stressors most strongly influence surgical outcomes.