Psychological factors associated with postoperative cognitive outcomes in older adults—a systematic review and meta-analysis
Anahita Amirpour, Lina Bergman, Jeanette Eckerblad, Gabriela Markovic, Ulrica Nilsson, Anna FalkAbstract
Introduction
Older adults face heightened risk of postoperative cognitive complications, which can prolong hospitalization and impair function. Preoperative psychological factors may contribute to these cognitive outcomes, yet their impact remains unclear. This systematic review and meta-analysis synthesizes evidence on associations between psychological factors and postoperative cognitive outcomes in older adults.
Methods
Systematic review and meta-analysis, including synthesis without meta-analysis (SWiM)of studies reporting preoperative psychological factors and postoperative cognitive outcomes in adults aged 60 years or older. Five databases (Medline, Embase, Web of Science, PsycINFO, and CINAHL) were searched. Where feasible, random-effects meta-analyses were conducted alongside p-value synthesis and vote counting based on direction of effect.
Results
Thirty studies (n = 6714 patients) were included. Four categories of psychological factors were identified: depression, anxiety, personality traits, and stress-related factors. Postoperative delirium was the most reported outcome, assessed in all studies with incidence ranging from 9–55.6%. Two studies assessed delayed neurocognitive recovery or postoperative neurocognitive disorder. In studies reporting effect estimates, the random effects model showed a non-significant association between depression and postoperative delirium (OR 1.08, 95% c.i. 0.97, 1.20). There was evidence of an association between the psychological factors and postoperative cognitive outcomes in 28 studies (P < 0.001) in SWiM.
Discussion
Depression was the most consistently reported psychological risk factor for postoperative delirium in older adults, while evidence for anxiety, personality traits, and stress is limited. Multidimensional, standardized cognitive assessments are needed, and future studies should evaluate interventions to reduce risk and improve postoperative cognitive outcomes.