Is the Compassion of Anesthesiologists Associated With Postoperative Pain and Patient Experience? A Prospective Cohort Study
Anesthesia Analgesia
Submitted September 2025 by Dr Andrew O’Donoghue
Read by 15 Journal Watch subscribers
Summary
This study, published in Anaesthesia & Analgesia (2025), investigates the role of anaesthesiologist compassion in shaping postoperative outcomes among patients undergoing same-day surgery. The authors begin by situating compassion within the broader context of medical care, noting prior evidence linking compassionate interactions with improved outcomes in chronic disease and primary care, as well as reduced perioperative anxiety and pain. Compassion is carefully distinguished from empathy: empathy being resonance with patient emotions, while compassion implies concern accompanied by a desire to help.
In modern surgical care, where anaesthesiologist-patient interactions are often limited to the day of surgery, opportunities for meaningful compassionate engagement are compressed. The study aimed to test whether higher levels of perceived compassion from the anaesthesiologist, as rated by patients, were associated with lower postoperative pain scores, with preoperative state anxiety hypothesised as a mediator. Exploratory outcomes included opioid consumption and patient experience metrics.
This was a prospective, single-centre observational study enrolling 147 patients between March 2021 and June 2022. Eligible patients underwent open abdominal, gynaecological, urological, oncological, or breast surgery in an ambulatory or 23-hour admission context. Compassion was measured using a validated five-item scale; anxiety was assessed using the State-Trait Anxiety Inventory; and pain was measured on an 11-point Likert scale over postoperative days (POD) 0–3. Analyses included correlation testing, linear mixed models, and counterfactual-based mediation to isolate the effect of anxiety in the compassion–pain relationship.
Results
The cohort was predominantly female (87%) and white (73%), with a median age of 50 years. Half underwent breast surgery, and 35% had abdominal surgery. Missing data were minimal (≤11% overall for pain scores).
The key finding was that higher compassion ratings were significantly associated with reduced state anxiety after the anaesthesiologist interview, and this reduction in anxiety mediated lower postoperative pain scores on POD 0. Specifically, for each unit increase in compassion, state anxiety decreased by 0.38 points (P = .0045). The mediated reduction in pain on POD 0 ranged from −0.02 to −0.13 on the Likert scale. By POD 1, the mediation effect unexpectedly reversed direction (increased pain with higher compassion), which the authors attributed to unmeasured home and social factors after discharge. No significant effects were observed on POD 2–3.
Compassion scores were also strongly associated with improved patient experience ratings on CAHPS-derived measures (ρ = −0.53, P < .01). As expected, opioid consumption correlated positively with pain across all postoperative days, but compassion did not show a direct association with opioid use.
Commentary
This study provides novel empirical evidence that compassion from anaesthesiologists can meaningfully reduce immediate postoperative pain, mediated by reduced preoperative anxiety. Its strengths include the use of validated scales for compassion and anxiety, prospective data collection, and adherence to STROBE reporting standards. The application of a mediation model based on counterfactual analysis allowed for a nuanced exploration of causal pathways.
However, several limitations temper the generalisability of findings. First, the single-centre design, predominantly female and white cohort, and high proportion of breast surgery cases introduce selection bias. Exclusion of laparoscopic and orthopaedic surgeries further narrows applicability. The sample size (n = 147) is modest, raising concerns about statistical power, especially for mediation analyses across multiple days.
Second, while blinding anaesthesiologists to outcomes was a strength, all providers were informed of the study beforehand, raising the possibility of a Hawthorne effect. Patients also knew compassion was being rated, which could have influenced perceptions. The absence of compassion assessments for resident or nurse anaesthetist interactions may also overlook key contributors to patient experience.
Third, the observed effect on pain was modest in magnitude and confined to POD 0, diminishing quickly after discharge. This suggests compassion’s impact may be context-dependent, most salient in the anxiety-provoking perioperative hospital environment. The unexpected association with increased pain on POD 1 highlights the influence of unmeasured external factors, such as social support or discharge preparation.
Despite these caveats, the study has important implications. It underscores the anaesthesiologist’s unique role in mitigating preoperative anxiety – a near-universal phenomenon among surgical patients – which in turn may reduce pain and improve satisfaction. The findings support integrating compassion training into anaesthesiology residency curricula and suggest future research should explore structured interventions (e.g., communication training, empathy-focused scripts) in larger, more diverse cohorts.
This study adds weight to the argument that compassion is not merely an interpersonal virtue but a measurable, clinically relevant factor in perioperative care. While limited by scope and design, it provides a valuable foundation for future trials examining compassion as an intervention to improve surgical outcomes.
