Social and behavioral factors emerging as key predictors of recovery quality after surgery

Editor's Note

Patients’ social conditions, language, and sleep patterns may play a larger role in surgical recovery than previously recognized, according to three studies presented at the ANESTHESIOLOGY® 2025 annual meeting that took place on October 10–14.

Researchers from the University of California, San Diego, found patients facing food insecurity or loneliness were significantly more likely to develop chronic pain after surgery. Reviewing data from more than 8,000 adults, the study determined food-insecure patients were 83% more likely to experience persistent pain one year postoperatively, while loneliness increased risk by 2% per point on a standardized scale. Authors urged clinicians to screen for social factors such as nutrition and social support before surgery, emphasizing unmet basic needs can delay healing and extend pain duration.

A second study, led by Beth Israel Deaconess Medical Center and Harvard Medical School, linked primary language to delirium risk. Among nearly 50,000 patients aged 60 and older, those whose first language was not English were 23% more likely to develop postoperative delirium, and that risk rose to 31% for those with lower income levels. The researchers said language barriers may impede communication and orientation after surgery, even when interpreter services are available, suggesting the need for multilingual care teams and family involvement early in recovery.

The third study, from Duke University, identified excessive daytime sleepiness as a marker for cognitive decline after surgery. In a cohort of older adults, those who reported moderate to severe daytime drowsiness experienced greater memory and thinking problems 6 weeks postoperatively. Investigators called for routine preoperative screening for sleepiness, which may indicate underlying disorders such as sleep apnea or depression that elevate the risk of perioperative neurocognitive disorder.

Together, the findings illustrate patient outcomes are deeply tied to factors beyond the OR—ranging from sleep and social support to communication access—highlighting opportunities for perioperative teams to take a more holistic approach to surgical care.