The effect of patient resilience on perioperative outcomes: a scoping review

Psychological resilience, the capacity to recover from adversity, may represent a modifiable perioperative risk factor. This scoping review evaluated how resilience is measured and its association with postoperative outcomes in adults undergoing surgery.

Structured searches of Ovid MEDLINE, Embase, and Joanna Briggs Institute Evidence-Based Practice (up to April 2024) identified studies assessing resilience in adult surgical patients. After duplicate review, studies were included if they reported preoperative resilience measurement and its association with postoperative outcomes. Narrative synthesis of outcomes followed; these were categorised according to the Institute for Healthcare Improvement Triple Aim framework.

A total of 74 studies (n=11; 710 patients) met inclusion criteria, using seven validated tools to measure resilience, most commonly the Brief Resilience Scale (n=31; 41.9%) and Connor-Davidson Resilience Scale (n=22; 29.7%). Resilience was assessed at a single timepoint in 54 studies and at multiple timepoints in 20 studies. Of 36 studies (n=6802) exploring associations between preoperative resilience and postoperative outcomes, 25 (69.4%) reported on the patient experience domain, 26 (72.2%) on health outcomes (72.2%), and three (8.3%) on cost. Higher resilience was frequently associated with improved patient experience (e.g. quality of life, satisfaction, mental health, and pain), and certain functional outcomes. Limitations included heterogeneous definitions of resilience, a preponderance of single-centre studies, and generally low-quality evidence driven by inconsistent results, bias, and limited adjustment for confounders.

Resilience measurement and its association with perioperative outcomes are variable. Emerging evidence suggests potential protective effects, warranting standardised longitudinal assessment in more diverse surgical populations.

Open Science Framework (https://osf.io/j4cqs).