Preoperative psychological factors are associated with postoperative cognitive outcomes in older adultsPsychological factors linked to cognitive issues after surgery in older adults

This systematic review and meta-analysis evaluated the relationship between preoperative psychological factors and postoperative cognitive outcomes in older adults. The study population consisted of older adults aged 60 years or older, with a total sample size of n=6714. The primary outcome measured was postoperative cognitive outcomes, specifically including postoperative delirium, delayed neurocognitive recovery, and postoperative neurocognitive disorder. The review utilized random-effects meta-analyses alongside P-value synthesis and vote counting to assess the data. Funding or conflicts of interest were not reported for this publication.

The intervention or exposure of interest involved preoperative psychological factors, which included depression, anxiety, personality traits, and stress-related factors. The comparator was not reported in the source data. The analysis did not report specific dosing or protocol details because these were psychological characteristics rather than pharmacological interventions. Safety and tolerability findings were not reported, and there were no recorded adverse events, serious adverse events, or discontinuations in the available data.

Regarding primary outcome results, the analysis found a non-significant association between depression and postoperative delirium. The effect size for this specific association was an odds ratio of 1.08. The 95% confidence interval for this odds ratio ranged from 0.97 to 1.20. In contrast, the evidence indicated an association between psychological factors and postoperative cognitive outcomes overall. This broader association was supported by a P value less than 0.001. The direction of this association was positive, indicating a link between the psychological factors and the cognitive outcomes.

Key secondary outcomes were not reported in the input data. The safety profile of the psychological factors could not be detailed because adverse events were not reported. Tolerability was not reported, and discontinuations were not reported. The study did not provide specific data on serious adverse events or general tolerability metrics. These gaps limit the ability to fully assess the risk-benefit profile of addressing these preoperative factors.

Methodological limitations included limited evidence for anxiety, personality traits, and stress regarding their impact on postoperative cognitive outcomes. The authors noted that multidimensional, standardised cognitive assessments are needed to better understand these relationships. Potential biases may exist due to the heterogeneity of psychological assessments across the included studies. The certainty of the evidence is tempered by the fact that associations were observed rather than causality, and the evidence for specific factors like anxiety remains limited.

Clinical implications suggest that multidimensional, standardised cognitive assessments are needed for better risk stratification. Future studies should evaluate interventions designed to reduce risk and improve postoperative cognitive outcomes in this vulnerable population. Practitioners should recognize that while depression showed a non-significant link to delirium, other psychological factors may still influence cognitive recovery. Questions remain unanswered regarding the specific mechanisms linking these psychological states to neurocognitive decline.

The study design was a systematic review and meta-analysis. The setting was not reported in the input data. The population was strictly defined as older adults aged 60 years or older. The intervention or exposure was preoperative psychological factors. The comparator was not reported. The main results demonstrated a P value less than 0.001 for the association between psychological factors and postoperative cognitive outcomes. The odds ratio for depression and postoperative delirium was 1.08 with a 95% confidence interval of 0.97 to 1.20. Safety data were not reported. Limitations included the need for standardised assessments. Practice relevance highlights the need for better assessment tools. Causality notes emphasize that these are associations. The certainty note mentions random-effects meta-analyses. Do not overstate the association between anxiety, personality traits, and stress and postoperative cognitive outcomes.