Preoperative Social Connection and Postoperative Outcomes in Adults Undergoing Surgery: A Systematic Review and Meta-analysis
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Importance
Social connection is routinely recorded in surgical cohorts but rarely analyzed as an exposure, leaving its prognostic value unsummarized.
Objective
To determine whether weaker preoperative social connection is associated with adverse postoperative outcomes.
Data Sources
PubMed/MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycInfo, CENTRAL; inception to July 17, 2026; 33,301 records, 20,399 after deduplication.
Study Selection
Studies of adults undergoing surgery with preoperatively ascertained social connection analyzed against a protocol-listed outcome; of 1,550 reports assessed, 454 reports of 445 studies were included.
Data Extraction and Synthesis
PRISMA and MOOSE reporting; PROSPERO CRD420261449181. Estimate selection followed a frozen, direction-blind hierarchy; k denotes analysis weight units. Random-effects models used restricted maximum likelihood (REML) with modified Hartung-Knapp intervals; risk of bias, result-level Quality in Prognosis Studies (QUIPS); certainty, prognostic Grading of Recommendations Assessment, Development and Evaluation (GRADE). Artificial intelligence agents screened and extracted; 2 reviewers unblinded to their output confirmed all 39 principal-analysis estimate records.
Main Outcomes and Measures
Postoperative all-cause survival (primary); early postoperative mortality, non-home discharge, unplanned readmission, any or major complications (secondary).
Results
Poolable estimates came from 72 of 445 studies, mostly of marital status. Each principal analysis included up to 63,779 to 298,340 patients or procedures (upper bounds; cohorts recur across outcomes, so no overall total). For the primary outcome, postoperative survival, the confidence interval (CI) included 1 (9 units; hazard ratio, 1.37; 95% CI, 0.99-1.89; certainty very low). Weaker connection was associated with early postoperative mortality (8 units; odds ratio, 1.50; 95% CI, 1.12-2.01; certainty low) and non-home discharge (9 units; OR, 1.95; 95% CI, 1.35-2.81; certainty low). CIs included 1 for unplanned readmission (9 units; OR, 1.14; 95% CI, 0.98-1.33; certainty low) and complications (4 units; OR, 1.10; 95% CI, 0.96-1.25; certainty very low). All estimable prediction intervals included the null. No eligible study estimated the association with failure to rescue.
Conclusions and Relevance
Preoperative social connection is a potential prognostic signal with substantial uncertainty. The largest association concerned discharge destination, partly shaped by the exposure itself, supporting early identification of support needs, not candidacy restriction. Whether changing social connection alters outcomes was not directly evaluated.
Key Points
Question
Among adults undergoing surgery, is weaker preoperative social connection associated with adverse postoperative outcomes?
Findings
In this systematic review and meta-analysis of 445 studies (33 in 5 principal analyses), all pooled estimates exceeded 1, the primary CI included 1 (HR, 1.37; 95% CI, 0.99-1.89) and CIs excluded 1 for early postoperative mortality (OR, 1.50) and non-home discharge (OR, 1.95), yet prediction intervals included 1 and certainty was low or very low.
Meaning
Preoperative social connection—in this literature, mostly marital status—is a potential prognostic signal with substantial uncertainty; it can inform support assessment and discharge planning, not candidacy.
