Can preoperative psychological factors increase my risk of Postoperative Delirium in older adults?

Postoperative delirium (POD) is a sudden change in attention and thinking that can happen after surgery, especially in older adults. Your mental state before surgery may play a role. Research shows that psychological factors such as depression, anxiety, and stress are linked to a higher risk of developing delirium after an operation. This answer explains what the evidence says and what you can discuss with your doctor.

What the research says

A systematic review and meta-analysis of 30 studies found that preoperative psychological factors are associated with postoperative cognitive outcomes in older adults ². The review identified four categories of psychological factors: depression, anxiety, personality traits, and stress-related factors. Postoperative delirium was the most commonly reported outcome, with incidence ranging from 9% to 55.6% across studies ². This suggests that your emotional state before surgery may influence your risk.

Another meta-analysis of risk factors for postoperative delirium in oral and maxillofacial surgery patients found that insomnia (a sleep problem often linked to stress and anxiety) was associated with a more than twofold increase in delirium risk (odds ratio 2.27) ³. While this study focused on a specific surgery type, it highlights how psychological factors like poor sleep can contribute.

A large individual patient data meta-analysis of over 8,000 patients undergoing noncardiac surgery confirmed that preoperative factors, including psychological ones, are important predictors of delirium ⁸. The study found that almost 1 in 5 patients developed delirium, and risk factors included age, frailty, and cognitive impairment ⁸. Although this analysis did not isolate psychological factors, it underscores the importance of overall preoperative vulnerability.

A narrative review on perioperative neurocognitive disorders notes that identifying vulnerable patients before surgery is key to prevention ⁹. It recommends preoperative screening for delirium and cognitive issues, which can include psychological assessments ⁹. Another review emphasizes that targeting risk factors, including psychological ones, can reduce short- and long-term consequences of delirium ¹⁰.

What to ask your doctor

• Should I be screened for depression or anxiety before my surgery?
• How might my current stress levels affect my recovery and delirium risk?
• Are there steps I can take before surgery to improve my mental well-being?
• What non-drug approaches (like relaxation techniques) could help lower my risk?
• If I have a history of insomnia, should I discuss sleep management before surgery?