Integrated Perioperative Care Model Improves Recovery in Older Surgical Patients

Many also take central nervous system–active medications that increase the risk of delirium, falls, and persistent pain. Given the difficulty of scaling timely mental health support and medication review within routine perioperative care, a new randomized clinical trial shows that combining structured mental health care with medication optimization can improve postoperative recovery in this population.

Researchers at Washington University School of Medicine in St. Louis (WashU Medicine; St. Louis, MO, USA) evaluated a care model developed through the Center for Perioperative Mental Health. The approach targets two common, modifiable factors in older surgical candidates: emotional distress and exposure to high-risk medications such as sedatives, muscle relaxants, and over-the-counter sleep aids. Up to 33% of older surgical patients experience depression and 22% report anxiety before surgery, yet these symptoms often go untreated as traditional perioperative pathways focus primarily on physical recovery.

The trial enrolled 306 adults aged 60 years and older who were scheduled for cardiac, oncologic, or orthopedic surgery across hospitals in the BJC HealthCare system. Participants with mild to moderate symptoms of depression and anxiety were randomized to receive either self-help materials alone or a multicomponent intervention that began before surgery. 

The intervention included eight to 12 phone sessions with a dedicated wellness coach, delivered by trained mental health professionals such as a social worker or mental health counselor, along with a pharmacist- and physician-led review to safely optimize doses of high-risk medications. All patients received educational materials on mindfulness, sleep, and brain health.

Three months after surgery, the intervention group showed a 2.2- to 2.5-point greater reduction in depression and anxiety symptoms on a 48-point scale compared with those who received educational materials alone. Older adults undergoing cancer surgery had the largest benefit, with scores nearly five points lower than controls. Patients also reported positive experiences with both the coaching and medication optimization components. Published September 9, 2026, in JAMA Network Open, the findings support integrating mental health care and medication review into routine pre-surgical workflows.

“The time around surgery is a window of both risk and opportunity. The stress of surgery can worsen anxiety and depression symptoms and affect patients’ recovery and overall health, but it also offers a critical opportunity to identify these concerns proactively and connect patients with the support they need,” said Joanna Abraham, PhD, a professor in the Department of Anesthesiology at WashU Medicine.

“The results of this trial suggest that anesthesiology and psychiatry can unite to treat surgical patients more holistically, pioneering a practical blueprint that hospital systems nationwide can use to improve recovery after invasive procedures,” said Michael S. Avidan, MBBCh, the Dr. Seymour and Rose T. Brown Professor of Anesthesiology, who serves as the Center’s co‑director.

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