Major Surgery Does Not Harm Mental Health

Undergoing surgery may lead to a small decline in physical health, but mental health is not affected, a new study finds.

In the UK Whitehall II study, 7920 adults completed multiple Short Form 36 (SF-36) quality of life assessments between 1997 and 2016. Compared with no hospitalization, major surgery was significantly associated with a mean decrease 0.79 point physical component summary (PCS) but no change in mental component summary (MCS) of SF-36, Robert D. Sanders, MBBS, PhD, Royal Prince Alfred Hospital, Camperdown, New Wales South Australia, and colleagues reported in JAMA Surgery. In a subgroup analysis of patients who underwent emergency versus non-emergency surgery, only PCS decreased significantly (-0.91 points).

In contrast, a major medical admission was significantly associated with a mean 1.46-point decrease in PCS and a 0.47-point decrease in MCS, compared with no admission.

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The researchers also calculated the odds of a substantial decline in quality of life, defined as more than 2 standard deviations from a predicted trajectory. Undergoing major surgery, medical admission, or both was significantly associated with a 1.8-fold, 2.2-fold, and 2.9-fold increase in the odds of a substantial decrease in PCS, respectively, compared with no admission. Only patients with both a medical and a surgical admission had a significant 2.0-fold increase in the odds of a substantial decrease in MCS.

Overall, effect sizes were below the clinically relevant threshold of 5 points, Dr. Sanders’ team explained. Compared with a stroke-related admission, a control condition, quality-of-life impairments from major surgery and major medical care were smaller.

“Major medical admissions were associated with decreased mental and physical quality of life, whereas major surgical admissions were only associated with changes in physical components of quality of life,” the researchers concluded.

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Krause BM, Manning HJ, Sabia S, et al. Association of major surgical admissions with quality of life: 19-year follow-up of the Whitehall II longitudinal prospective cohort study.. J.A.M.A. Surgery. Published online January 26, 2022. doi:10.1001/jamasurg.2021.7132

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