Unexpected Consequences, Problems after Surgery

Rather than having a restorative health experience, one in seven patients experience more pain, physical and emotional problems a year after surgery.

The new study also finds that a quarter of individuals have less vitality when assessed a year after surgery.

Those are the key findings of a research study of more than 400 patients published online by the British Journal of Surgery.

Researchers from The Netherlands spoke to 216 women and 185 men with an average age of 54, who had undergone planned surgery, ranging from plastic surgery to orthopaedic surgery.

They used the SF-36 health survey to measure pain, physical functioning, mental health and vitality before surgery and six and 12 months after each patient’s operation.

The researchers also asked patients how far they had moved toward 100 percent recovery at six and 12 months after surgery.

“Our study showed poor recovery was relatively frequent six and 12 months after surgery and could be partly explained by various physical and psychological factors,” says Dr. Madelon Peters from the Department of Clinical Psychological Science at Maastricht University.

“These included acute postoperative pain and presurgical anxiety.”

Key findings included:

• More than half of the patients (53 percent) said that their pain levels had improved 12 months after their operation and 29 percent said they were stable, but 17 percent reported greater pain.
• Most patients had better (43 percent) or similar (43 percent) functional abilities at 12 months, but 14 percent said their functional abilities had reduced.
• At 12 months, 34 percent of patients had better mental health, 50 percent did not change and 16 percent had poorer mental health.
• Vitality increased in 39 percent of patients, remained the same in 37 percent and fell in 24 percent at 12 months.
• When it came to overall recovery, patients reported that their average level of recovery was 79 percent at six months and 82 percent at 12 months. Only 47 percent of patients had achieved near optimal recovery – defined as 90 percent or more – at 12 months, with 15 percent perceiving their recovery at 50 percent or less.

“Our research found that 15 percent of patients were still reporting pain and physical and emotional problems a year after surgery and 24 percent felt they had less vitality than before their operation,” says Dr. Peters.

“The strongest predictor of pain intensity at followup was the level of pain in the first four days after the patient’s operation. Higher levels of acute postoperative pain were also associated with poorer long-term physical functioning and overall perceived recovery.

“We also found a significant association between patients who were worried before their operation about the consequences of surgery and lower than average improvements in physical functioning and vitality at followup. Most of the changes in health-related quality of life occurred during the first six months after surgery, after which the patients’ conditions appeared to remain stable. It is clearly important to monitor how patients recover during this period as an initially poor recovery may have lasting consequences.”

Source: Wiley-Blackwell