Association between psychological health and wound complications after surgery

Background: Surgical wound complications remain a major cause of morbidity, leading to higher costs and reduced quality of life. Whilst psychological health is widely considered to affect wound healing, the evidence on wound outcomes after surgery is mixed. Studies generally focus on small samples of patients undergoing a specific procedure and have limited statistical power.

Methods: We investigated the relationship between three different measures of anxiety and/or depression and seven adverse surgical outcomes using observational data collected before and after surgery between 2009 and 2011. We adjusted for a wide range of confounding factors including patient demographics, physical comorbidities, health-related behaviours, month of operation, procedure complexity, and treating hospital.

Results: The estimation sample included 176827 patients undergoing 59410 hip replacements, 64145 knee replacements, 38328 hernia repairs, and 14944 varicose vein operations. Patients with moderate anxiety or depression were associated with an increased probability of developing a wound complication (OR 1.17, 95% CI: 1.11 to 1.24) within 6 months of a hip replacement. They were more likely to be readmitted from a wound complication (OR 1.20, 95% CI: 1.02 to 1.41) and faced increased length of stays by 0.19 days (95% CI: 0.15 to 0.24). Estimated associations were consistent across all four types of operation and for each measure of anxiety and/or depression.

Conclusion: Preoperative psychological health is a significant risk factor for wound outcomes after surgery for four of the most commonly performed procedures in England. This finding warrants further exploration in order to understand the mechanisms and mediating factors required to identify effective interventions.