Duke study links stress to poorer surgical recovery outcomes for older adults

A new study from Duke University School of Medicine suggests that preoperative stress checks can improve surgical outcomes for older adults. Duke claims the study is “one of the most in-depth looks at pre-surgery stress in the general geriatric surgical population.”

The study, published in Anesthesiology, says that even modest stress can affect how older adults recover from surgery. Stressed older adults, it says, face higher risks of delirium, experience more uncontrolled pain, and spend extra days in the hospital postoperatively. In some cases, the patients didn’t consider themselves to be highly stressed going into their surgeries.

Senior study author and Duke Health anesthesiologist Leah C. Acker, MD, PhD, told the Duke University School of Medicine website that providers would be well-served by identifying and addressing patient stress preoperatively to improve surgical outcomes. Dr. Acker added that small stressors can combine to hinder recoveries.

The researchers used a three-minute, tablet-based version of the National Comprehensive Cancer Network Distress Thermometer with 132 patients between November 2022 and December 2024, Duke reports, adding that “patients rated their distress before surgery, selected concerns from a 39-item checklist and shared open-ended thoughts.” The study uncovered stressors including sleep and appetite changes, communication with the healthcare team, and family-related stress, says Duke.

“These are very common concerns, and many are ones we can address,” Dr. Acker said in the Duke report. “As the anesthesiologist, I have things I’m responsible for to keep a patient safe, 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.”

She described the patients who were surveyed, including open-ended responses, as “honest and vulnerable. You don’t know what someone is carrying unless you ask -- and ask in a structured way.”

Read the full Duke article here and the full study here.