Utility of a Measure of Resilience As a Preoperative Screening Tool to Rule Out Elevated Psychological Symptom Burden

BACKGROUND: Psychosocial health is an important predictor of surgical outcomes. Resilience, defined as the ability to "bounce back" from adversity, has been associated with various outcomes, but no consensus exists on measuring resilience in surgical populations. The Connor-Davidson Resilience Scale (CD-RISC), a widely used instrument, has not been explored in relation to other psychometric scales. This study compared CD-RISC with measures of psychological symptom burden to inform future evaluations of whether interventions that improve resilience also improve postoperative outcomes. METHODS: This cross-sectional study analyzed secondary data from the baseline assessment within a larger randomized controlled trial, comprising 265 adults scheduled for major abdominal or pelvic surgery who completed preoperative research surveys, including the CD-RISC-10; Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety, Depression, Sleep Disturbance short forms; and Pain Catastrophizing Scale (PCS). Patients were stratified into low, normal, and high resilience groups using ±1 standard deviation thresholds. Group differences were tested using multivariable analysis of variance (MANOVA) with follow-up analysis of variance (ANOVAs). Spearman's correlations quantified associations between resilience and symptom burden. Receiver operating characteristic (ROC) analyses evaluated whether CD-RISC scores predicted elevated symptom burden. RESULTS: Multivariable analysis showed significant differences between CD-RISC strata across all measures (Pillai's trace = 0.29, F(8, 520) = 11.0, P < .001, = 0.15). Follow-up analyses revealed the strongest effects for anxiety (F(2, 262) = 38.8, P < .001, = 0.23) and depression (F(2, 262) = 39.4, P < .001, = 0.23), and modest effects for sleep disturbance (F(2, 262) = 10.9, P < .001, = 0.08) and pain catastrophizing (F(2, 262) = 10.9, P < .001, = 0.08). Spearman's correlations demonstrated moderate negative associations between resilience versus anxiety (ρ = -0.48 [-0.57 to -0.38], P < .001) and depression (ρ = -0.50 [-0.59 to -0.40], P < .001); and modest negative associations versus sleep disturbance (ρ = -0.30 [-0.42 to -0.18], P < .001) and pain catastrophization (ρ = -0.31 [-0.42 to -0.19], P < .001). CD-RISC showed fair discrimination for ruling out elevated symptom burden using a composite of PROMIS and PCS scores (area under the curve [AUC] = 0.71 [0.63-0.78], specificity = 0.86 [0.81-0.90], cutoff ≤28). CONCLUSIONS: Preoperative resilience measured with CD-RISC demonstrates moderate negative associations with measures of anxiety and depression in preoperative patients. CD-RISC could be used as a brief preoperative screening tool to rule out elevated psychological symptom burden. Future studies should assess whether perioperative interventions to increase resilience can positively influence recovery outcomes such as risk of persistent postoperative opioid use.