Preoperative Social Connection and Postoperative Outcomes in Adults Undergoing Surgery: A Systematic Review and Meta-analysis

Weaker preoperative social connection is associated with increased risk of early postoperative mortality. Social connection is routinely recorded in surgical cohorts but rarely analyzed as an exposure, leaving its prognostic value unsummarized; this study is the first to quantify this association through systematic review and meta-analysis. Pooled estimate from 8 analysis weight units, OR 1.50 (95% CI 1.12-2.01), GRADE certainty low.

The strongest association was between weaker preoperative social connection and non-home discharge (e.g., transfer to a care facility). The magnitude of this association exceeded all other outcomes, suggesting that social connection has particularly pronounced predictive value for discharge destination. Pooled estimate from 9 analysis weight units, OR 1.95 (95% CI 1.35-2.81), GRADE certainty low; the authors note this association is partly shaped by the exposure itself.

Associations between preoperative social connection and postoperative survival, unplanned readmission, and complications were not statistically significant. Confidence intervals for these outcomes all included 1, indicating that existing evidence is insufficient to support a reliable association between social connection and these outcomes. Postoperative survival: 9 units, HR 1.37 (95% CI 0.99-1.89), certainty very low; unplanned readmission: 9 units, OR 1.14 (95% CI 0.98-1.33), certainty low; complications: 4 units, OR 1.10 (95% CI 0.96-1.25), certainty very low. All estimable prediction intervals included the null.

Preoperative social connection is a potential prognostic signal with substantial uncertainty. The study systematically reviewed 445 studies, but only 72 provided poolable estimates, mostly of marital status, revealing a gap between the breadth and depth of evidence in this field. Systematic search of 33,301 records, 20,399 after deduplication, 1,550 reports assessed, 454 reports of 445 studies included; PRISMA and MOOSE reporting, PROSPERO CRD420261449181, REML random-effects models with modified Hartung-Knapp intervals, QUIPS risk of bias, GRADE certainty assessment.

This study aimed to assess the association between preoperative social connection and postoperative outcomes in adults undergoing surgery. Results support early identification of social support needs rather than using social connection as a restriction on surgical candidacy. The study did not directly evaluate whether changing social connection alters outcomes, so intervention effects cannot be inferred.

All estimable prediction intervals included the null, suggesting future studies may reach different conclusions. Most poolable estimates concerned marital status only, with limited evidence on other dimensions of social connection (e.g., social networks, loneliness). No eligible study estimated the association between social connection and failure to rescue. Whether changing social connection improves outcomes was not directly evaluated. Additionally, this summary does not include figures and supplementary materials, which may affect deeper understanding of risk of bias and heterogeneity.