Older patients undergoing non-cardiac surgery reported a significantly greater degree of anxiety relating to surgery compared to anesthesia (MD 1.54), with complications, pain, and rehabilitation being the top concerns.
Meta-Analysis (n=1,777)
In older adults undergoing non-cardiac surgery, the primary preoperative concerns are complications, pain, and recovery, highlighting the need for tailored preoperative counseling.
Mean Difference: 1.54 (95% CI 1.12–1.95)
p-value: p=<0.00001
Background Older adults (≥ 50 years) possess unique preoperative concerns influenced by age-related needs, perceptions, and health status. When left unaddressed, these concerns are risk factors for postoperative morbidity and mortality. Despite the aging demographic, these concerns in older patients have not been systematically examined. This systematic review and meta-analysis aims to summarize the preoperative concerns of older patients. Methods Five databases were searched from January 1, 2000 to March 26, 2023. Studies with 1) patients ≥ 50 years undergoing non-cardiac surgery; 2) concerns identified preoperatively with validated instruments; 3) at least one preoperative concern reported (mean, degree or incidence of concern); 4) randomized controlled trials, prospective cohort, or cross-sectional studies were included. Concerns were classified into domains and subdomains. Meta-analysis was performed when two or more studies assessed concerns utilizing the same instrument. Results Seventeen studies with 1,777 patients were included. The mean age was 68.3 ± 9.9 years, with 51.4% female. Surgeries were classified as mixed, orthopedic (elective or emergent), and high-burden (abdominal, vascular, oncological). Concerns were categorized into domains: 1) anesthesia, 2) surgery, 3) pain, 4) complications, 5) medical experience, 6) recovery and rehabilitation, and 7) impact on daily life. Patients reported a greater degree of anxiety relating to surgery than anesthesia: 1.54 (95% CI: 1.12-1.95, P<0.00001). The top three concerns across all surgeries (mixed, orthopedic, and high-burden) were complications, pain, and rehabilitation/recovery. Pain and complications were the greatest concerns in elective orthopedic procedures and emergent procedures, respectively. In high-burden surgeries, patients were primarily concerned about complications. Conclusion Surgery-related concerns were 50% greater than anesthesia-related concerns. The three main concerns in older patients were complications, pain, and rehabilitation/recovery. The top concerns varied among specific surgical types. These findings emphasize the importance of tailoring preoperative counseling to address specific fears of each surgical population.
Qu et al. (Fri,) conducted a meta-analysis in Preoperative concerns in non-cardiac surgery (n=1,777). Surgery-related concerns vs. Anesthesia-related concerns was evaluated on Degree of anxiety relating to surgery versus anesthesia (MD 1.54, 95% CI 1.12-1.95, p=<0.00001). Older patients undergoing non-cardiac surgery reported a significantly greater degree of anxiety relating to surgery compared to anesthesia (MD 1.54), with complications, pain, and rehabilitation being the top concerns.
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