Preoperative Concerns of Older Patients Undergoing Non-cardiac Surgery: A Systematic Review and Meta-analysis

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.

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.

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.

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.