Mental Health Disorders (MHD) are a growing concern nationwide. The significant impact MHD have on surgical outcomes has only recently started to be understood. This literature review investigated how mental health impacts the outcomes of general surgery patients and what can be done to make improvements. Patients with schizophrenia had the poorest surgical outcomes. Mental health disorders increased post-surgical pain, hospital length of stay, complications, readmissions, and mortality. Mental health disorders decreased wound healing and quality of care. Optimizing outcomes will be best accomplished through integrating more effective perioperative screening tools and interventions. Screenings tools can incorporate artificial intelligence, MHD data, resilience and its biomarkers, and patient mental health questionnaires. Interventions include cognitive behavioral therapy, virtual reality, spirituality, pharmacology, and resilience training.
<Key Substance use and mental health indicators in the United States Results from the 2019 National Survey on Drug Use and Health.pdf>.
2.
LatifAShamsher KhanRMNawazK. Depression and anxiety in patients undergoing elective and emergency surgery: Cross-sectional study from Allama Iqbal memorial teaching hospital, Sialkot. J Pak Med Assoc. 2017;67(6):884-888.
3.
SacksOAGoldwagJLEidMAShawRDWilliamsTJIvaturySJ. Poor baseline health of IBD patients at presentation to a surgeon: Results from a patient-reported outcomes database. Crohn’s & Colitis 360. 2021;3(1):1-7. doi:10.1093/crocol/otaa096
4.
McIntyreLKArbabiSRobinsonEFMaierRV. Analysis of risk factors for patient readmission 30 days following discharge from general surgery. JAMA Surg. 2016;151(9):855-861. doi:10.1001/jamasurg.2016.1258
5.
McBrideKESolomonMJBannonPGGlozierNSteffensD. Surgical outcomes for people with serious mental illness are poorer than for other patients: A systematic review and meta-analysis. Med J Aust. 2021;214(8):379-385. doi:10.5694/mja2.51009
6.
GermackHDCaronASolomonRHanrahanNP. Medical-surgical readmissions in patients with co-occurring serious mental illness: A systematic review and meta-analysis. Gen Hosp Psychiatr. 2018;55:65-71. doi:10.1016/j.genhosppsych.2018.09.005
ManumJVeithJWeiGKwokAAgarwalJ. Variables associated with length of stay in patients undergoing mastectomy and delayed-immediate breast reconstruction with tissue expander. Breast J. 2019;25(5):927-931. doi:10.1111/tbj.13375
9.
LeeDSMarshLGarcia-AltieriMAChiuLWAwadSS. Active mental illnesses adversely affect surgical outcomes. Am Surg. 2016;82(12):1238-1243. doi:10.1177/000313481608201233
10.
ManwellLABarbicSPRobertsK, et al.What is mental health? Evidence towards a new definition from a mixed methods multidisciplinary international survey. BMJ Open. 2015;5(6):e007079-e007079. doi:10.1136/bmjopen-2014-007079
11.
MaedaTBabazonoANishiTTamakiK. Influence of psychiatric disorders on surgical outcomes and care resource use in Japan. Gen Hosp Psychiatr. 2014;36(5):523-527. doi:10.1016/j.genhosppsych.2014.05.014
12.
CopelandLAZeberJESakoEY, et al.Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the veterans health administration. BMC Surg. 2015;15(1):74-74. doi:10.1186/s12893-015-0064-7
13.
GouinJPKiecolt-GlaserJK. The impact of psychological stress on wound healing: Methods and mechanisms. Immunol Allergy Clin North Am. 2011;31(1):81-93. doi:10.1016/j.iac.2010.09.010
14.
BritteonPCullumNSuttonM. Association between psychological health and wound complications after surgery. Br J Surg. 2017;104(6):769-776. doi:10.1002/bjs.10474
15.
JoshiGPBeckDEEmersonRH, et al.Defining new directions for more effective management of surgical pain in the United States: Highlights of the inaugural surgical pain congress. Am Surg. 2014;80(3):219-228.
16.
Sobol-KwapinskaMBąbelPPlotekWStelcerB. Psychological correlates of acute postsurgical pain: A systematic review and meta-analysis. Eur J Pain. 2016;20(10):1573-1586. doi:10.1002/ejp.886
17.
ParoAHyerJMPawlikTM. ASO author reflections: Association of depression with in-patient and post-discharge disposition and expenditures among medicare beneficiaries undergoing resection for cancer. Ann Surg Oncol. 2021;28:6535-6536. doi:10.1245/s10434-021-09848-5
18.
BaileyEAWirtallaCSharokyCEKelzRR. Disparities in operative outcomes in patients with comorbid mental illness. Surgery. 2018;163(4):667-671. doi:10.1016/j.surg.2017.09.029
19.
FoxJPPhilipEJGrossCPDesaiRAKilleleaBDesaiMM. Associations between mental health and surgical outcomes among women undergoing mastectomy for cancer. Breast J. 2013;19(3):276-284. doi:10.1111/tbj.12096
20.
RatcliffCGMassarwehNNSansgirySDindoLCullyJA. Impact of psychiatric diagnoses and treatment on postoperative outcomes among patients undergoing surgery for colorectal cancer. Psychiatr Serv. 2021;72(4):391-398. doi:10.1176/appi.ps.201900559
21.
HarfoucheMBeardJMasonL, et al.Outcomes in trauma patients with behavioral health disorders. J Surg Res. 2019;244:425-429. doi:10.1016/j.jss.2019.06.061
22.
SchlosserKAMaloneySRPrasadTKercherKHenifordBTAugensteinVA. The impact of preoperative anxiety, depression, and chronic pain on outcomes in abdominal wall reconstruction. Hernia. 2019;23(6):1045-1051. doi:10.1007/s10029-019-02059-8
23.
LitzMRigbyARogersAMLeslieDLHollenbeakCS. The impact of mental health disorders on 30-day readmission after bariatric surgery. Surg Obes Relat Dis. 2018;14(3):325-331. doi:10.1016/j.soard.2017.11.030
24.
BalentineCJNaikADRobinsonCNHermosillo-RodriguezJHBergerDH. Depression is associated with prolonged and complicated recovery following colorectal surgery. Gastroenterology (New York, NY 1943). 2011;140(5):S‐1003‐S‐1003. doi:10.1016/S0016-5085(11)64167-X
25.
SutherlandJLiuGCrumpTBairMKarimuddinA. Relationship between preoperative patient-reported outcomes and hospital length of stay: A prospective cohort study of general surgery patients in Vancouver, Canada. J Health Serv Res Policy. 2019;24(1):29-36. doi:10.1177/1355819618791634
26.
MitchellJEKingWCChenJY, et al.Course of depressive symptoms and treatment in the longitudinal assessment of bariatric surgery (LABS‐2) study. Obesity. 2014;22(8):1799-1806. doi:10.1002/oby.20738
27.
GaoJTsengCCBarinskyGL, et al.Exploratory analysis on the association of mental health disorders with in-hospital postoperative complications and mortality in head and neck cancer surgery. Head Neck. 2021;43(10):3022-3031. doi:10.1002/hed.26791
28.
HassidimABratman MoragSGiladiMDaganYTzadokRReissmanP, et al.. Perioperative complications of emergent and elective procedures in psychiatric patients. J Surg Res. 2017;220:293-299. doi:10.1016/j.jss.2017.07.018
29.
BastaMNFoxJPKanchwalaSK, et al.Complicated breast cancer-related lymphedema: Evaluating health care resource utilization and associated costs of management. Am J Surg. 2016;211(1):133-141. doi:10.1016/j.amjsurg.2015.06.015
30.
ParedesAZHyerJMDiazATsilimigrasDIPawlikTM. The impact of mental illness on postoperative outcomes among medicare beneficiaries: A missed opportunity to help surgical patients?Ann Surg. 2020;272(3):419-425. doi:10.1097/SLA.0000000000004118
31.
van der SluisFJMDBuismanPLMeerdinkMMD, et al.Risk factors for postoperative delirium after colorectal operation. Surgery. 2016;161(3):704-711. doi:10.1016/j.surg.2016.09.010
32.
AoyanagiNIizukaIWatanabeM. Surgery for digestive malignancies in patients with psychiatric disorders. World J Surg. 2007;31(12):2323-2328. doi:10.1007/s00268-007-9267-0
33.
KuruppuSGhaniMPritchardM, et al.A prospective investigation of depression and adverse outcomes in patients undergoing vascular surgical interventions: A retrospective cohort study using a large mental health database in South London. Eur Psychiatry. 2021;64(1):e13. doi:10.1192/j.eurpsy.2021.2
34.
FisherDColemanKJArterburnDE, et al.Mental illness in bariatric surgery: A cohort study from the PORTAL network. Obesity. 2017;25(5):850-856. doi:10.1002/oby.21814
35.
HanrahanNPBressiSMarcusSCSolomonP. Examining the impact of comorbid serious mental illness on rehospitalization among medical and surgical inpatients. Gen Hosp Psychiatr. 2016;42:36-40. doi:10.1016/j.genhosppsych.2016.06.002
36.
HashimotoNIsakaNIshizawaYMitsuiTSasakiM. Surgical management of colorectal cancer in patients with psychiatric disorders. Surg Today. 2009;39(5):393-398. doi:10.1007/s00595-008-3901-9
37.
AbramsTEVaughan-SarrazinMRosenthalGE. Influence of psychiatric comorbidity on surgical mortality. Arch Surg. 2010;145(10):947-953. doi:10.1001/archsurg.2010.190
38.
GhoneimMMO’HaraMW. Depression and postoperative complications: an overview. BMC Surg. 2016;16(1):5-5. doi:10.1186/s12893-016-0120-y
39.
WieghardNEHartKDHerzigDOLuKCTsikitisVL. Psychiatric illness is a disparity in the surgical management of rectal cancer. Ann Surg Oncol. 2015;22(suppl 3):S573-S579. doi:10.1245/s10434-015-4791-x
40.
SyedZRubinfeldI. Personalized risk stratification for adverse surgical outcomes: Innovation at the boundaries of medicine and computation. Pers Med. 2010;7(6):695-701. doi:10.2217/pme.10.69
41.
FosterCHavilandJWinterJ, et al.Pre-surgery depression and confidence to manage problems predict recovery trajectories of health and wellbeing in the first two years following colorectal cancer: Results from the CREW Cohort study. PLoS One. 2016;11(5):e0155434. doi:10.1371/journal.pone.0155434
42.
GrahamDBecerril-MartinezG. Surgical resilience: A review of resilience biomarkers and surgical recovery. Surgeon. 2014;12(6):334-344. doi:10.1016/j.surge.2014.03.006
43.
GrahamDBecerril-MartinezGQuintoLZhaoDF. Can we measure surgical resilience?Med Hypotheses. 2016;86:76-79. doi:10.1016/j.mehy.2015.12.001
44.
RaineyEEMSPetreyLBMDReynoldsMMSAgtarapSBAWarrenAMPD. Psychological factors predicting outcome after traumatic injury: The role of resilience. Am J Surg. 2014;208(4):517-523. doi:10.1016/j.amjsurg.2014.05.016
45.
MeyersPMLeedsILEnumahZO, et al.Missed psychosocial risk factors during routine preoperative evaluations are associated with increased complications after elective cancer surgery. Surgery. 2019;166(2):177-183. doi:10.1016/j.surg.2019.04.015
46.
KimSDuncanPWGrobanLSegalHAbbottRMWilliamsonJD. Patient-reported outcome measures (PROM) as a preoperative assessment tool. J Anesth Perioper Med. 2017;4(6):274-281.
47.
BasakFHasbahceciMGunerS, et al.Prediction of anxiety and depression in general surgery inpatients: A prospective cohort study of 200 consecutive patients. Int J Surg. 2015;23(Pt A):18-22. doi:10.1016/j.ijsu.2015.09.040
48.
GillisCLiCLeeL, et al.Prehabilitation versus rehabilitation: A randomized control trial in patients undergoing colorectal resection for cancer. Anesthesiology. 2014;121(5):937-947. doi:10.1097/ALN.0000000000000393
49.
Le RoyBSelvyMSlimK. The concept of prehabilitation: What the surgeon needs to know?J visc surg. 2016;153(2):109-112. doi:10.1016/j.jviscsurg.2016.01.001
50.
LambertJHayesLKeeganTSubarDGaffneyC. The impact of prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal cancer surgery: A PRISMA-accordant meta-analysis. Ann Surg. 2020;274(1):70-77. doi:10.1097/SLA.0000000000004527
51.
LjungqvistOScottMFearonKC. Enhanced recovery after surgery: A review. JAMA Surg. 2017;152(3):292-298. doi:10.1001/jamasurg.2016.4952
52.
FearonKCJenkinsJTCarliFLassenK. Patient optimization for gastrointestinal cancer surgery. Br J Surg. 2013;100(1):15-27. doi:10.1002/bjs.8988
53.
MatthewsHGrunfeldEATurnerA. The efficacy of interventions to improve psychosocial outcomes following surgical treatment for breast cancer: A systematic review and meta-analysis. Psychooncology. 2017;26(5):593-607. doi:10.1002/pon.4199
54.
RatcliffCGDeaversFTullosEA, et al.Brief behavioral intervention for distressed patients undergoing cancer surgery: A case series. Cognit Behav Pract. 2020;27(3):306-320. doi:10.1016/j.cbpra.2020.02.002
55.
BagheriHEbrahimiHAbbasiAAtashsokhanGSalmaniZZamaniM. Effect of preoperative visitation by operating room staff on preoperative anxiety in patients receiving elective hernia surgery. J Perianesth Nurs. 2019;34(2):272-280. doi:10.1016/j.jopan.2018.04.005
56.
AbelsonJSChaitAShenMJCharlsonMDickermanAYeoH. Coping strategies among colorectal cancer patients undergoing surgery and the role of the surgeon in mitigating distress: A qualitative study. Surgery. 2019;165(2):461-468. doi:10.1016/j.surg.2018.06.005
57.
NikumbVBBanerjeeAKaurGChaudhuryS. Impact of doctor-patient communication on preoperative anxiety: Study at industrial township, Pimpri, Pune. Ind Psychiatry J. 2009;18(1):19-21. doi:10.4103/0972-6748.57852
58.
SchrempfMCPetzoldJQVachonH, et al.Virtual reality-based relaxation for enhancement of perioperative well-being and quality of life: protocol for a randomised pilot trial. BMJ Open. 2021;11(4):e044193. doi:10.1136/bmjopen-2020-044193
59.
BieglerKCohenLScottS, et al.The role of religion and spirituality in psychological distress prior to surgery for urologic cancer. Integr Cancer Ther. 2012;11(3):212-220. doi:10.1177/1534735411416456
60.
NeffCTottenCPlymaleMOylerDRDavenportDRothJS. Associations between anxiolytic medications and ventral hernia repair. Hernia. 2018;22(5):753-757. doi:10.1007/s10029-018-1766-4
61.
WardNRothJSLesterCCMutisoLLommelKMDavenportDL. Anxiolytic medication is an independent risk factor for 30-day morbidity or mortality after surgery. Surgery. 2015;158(2):420-427. doi:10.1016/j.surg.2015.03.050
62.
GanTJacksonNACastleJT, et al.A retrospective review: Patient-reported preoperative prescription opioid, sedative, or antidepressant use is associated with worse outcomes in colorectal surgery. Dis Colon Rectum. 2020;63(7):965-973. doi:10.1097/DCR.0000000000001655
63.
HerrmanHStewartDEDiaz-GranadosNBergerELJacksonBYuenT. What is resilience?Can J Psychiatry. 2011;56(5):258-265. doi:10.1177/070674371105600504
64.
OngADZautraAJReidMC. Psychological resilience predicts decreases in pain catastrophizing through positive emotions. Psychol Aging. 2010;25(3):516-523. doi:10.1037/a0019384
65.
WeinribAZAzamMABirnieKABurnsLCClarkeHKatzJ. The psychology of chronic post-surgical pain: New frontiers in risk factor identification, prevention and management. British j pain. 2017;11(4):169-177. doi:10.1177/2049463717720636
66.
SturgeonJAZautraAJ. Psychological resilience, pain catastrophizing, and positive emotions: perspectives on comprehensive modeling of individual pain adaptation. Curr Pain Headache Rep. 2013;17(3):317. doi:10.1007/s11916-012-0317-4
67.
BroadbentEKoschwanezHE. The psychology of wound healing. Curr Opin Psychiatry. 2012;25(2):135-140. doi:10.1097/YCO.0b013e32834e1424
68.
BroadbentEKahokehrABoothRJ, et al.A brief relaxation intervention reduces stress and improves surgical wound healing response: A randomised trial. Brain Behav Immun. 2011;26(2):212-217. doi:10.1016/j.bbi.2011.06.014
69.
RobinsonHNortonSJarrettPBroadbentE. The effects of psychological interventions on wound healing: A systematic review of randomized trials. Br J Health Psychol. 2017;22(4):805-835. doi:10.1111/bjhp.12257
70.
LiuYSongXZhangYZhouLNiR. The effects of comprehensive mental intervention on the recovery time of patients with postsurgical gastroparesis syndrome. J Clin Nurs. 2014;23(21-22):3138-3147. doi:10.1111/jocn.12554
71.
VasdekisSNRoussopoulouALazarisA, et al.Stress management in patients undergoing carotid endarterectomy for carotid artery stenosis: A pilot randomized controlled trial. Ann Vasc Surg. 2015;29(7):1400-1407. doi:10.1016/j.avsg.2015.05.006
72.
TsimopoulouIPasqualiSHowardR, et al.Psychological prehabilitation before cancer surgery: A systematic review. Ann Surg Oncol. 2015;22(13):4117-4123. doi:10.1245/s10434-015-4550-z
