Date of Award

January 2024

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Ira L. Leeds


Objective: Patient-related, biological risk factors such as age, diabetes, and smoking are associated with worse outcomes and increased postoperative complications rates in patients. However, not much is known about the effects of psychosocial risk factors on surgical outcomes. This study aimed to characterize the psychosocial risk burden in patients undergoing major surgery for malignant and benign conditions. Methods: A prospective, comprehensive psychosocial risk assessment of adult patients undergoing major thoracic or abdominal surgery within the Yale New Haven Health system was conducted from July 2023 to December 2023. The study was delivered over telephone, and was comprised of validated survey instruments for anxiety, depression, resilience, self-efficacy, addiction, high-risk alcohol use, smoking history, and other social determinants of health. Categorical variables were reported as percentages and compared with a chi-squared test. Continuous variables were reported as mean and standard deviation or median and inter-quartile range and compared with a two-tailed t-test. Results: Of 102 surgical patients interviewed preoperatively, 56 (54.9%) had moderately severe to severe anxiety, 21 (20.6%) had moderate to severe depression, 14 (13.7%) had a history of or active addiction, 39 (38.2%) had high-risk alcohol use, 58 (56.9%) had a smoking history, 29 (28.4%) had low resilience, and 5 (4.9%) had limited resourcefulness. Most patients were of white race (93.1%), non-Hispanic ethnicity (92.2%), with either a college or graduate level education (27.5%), of middle socioeconomic status (SES) (52.9%), and female sex (54.9%). 61.8% of patients had high psychosocial risk. High risk alcohol use was more prevalent in white (40.0% vs 14.3%, p < 0.001), and male (41.3% vs 35.7%, p < 0.01) patients. Male (p < 0.01) and low SES (p < 0.05) patients were more likely to have a history of smoking. History of addiction was associated with having completed less than high school level of education and being of low SES. Low resilience was most prevalent in individuals with high SES (p < 0.001). Most patients were discharged home (95.6%) with a median length of stay of 4.25 days and did not have to be re-hospitalized (89.6%) within 30-days of their index hospital stay. Incidence of 30-day postoperative complications was limited (n = 7, 10.4%). Conclusion: Most patients undergoing major surgery at a tertiary academic center have multiple PSRFs that do not necessarily coincide with traditional indicators of increased psychosocial risk. Further investigation is required to determine associations between postoperative outcomes and specific psychosocial risk factors so that appropriate interventions can be implemented to optimize these risk factors in the preoperative setting.


This thesis is restricted to Yale network users only. It will be made publicly available on 04/30/2026