Preoperative Concerns of Older Patients Undergoing Non-cardiac Surgery: A Systematic Review and Meta-analysis
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.031 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.014 | 0.029 |
| Bibliometrics | 0.008 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".