Adult Post-operative Mental Health Outcomes Following Abdominal and Orthopedic Surgeries: A Scoping Review

Abstract

Poor mental health has been shown to negatively impact surgical outcomes; however, the impact of surgery on mental health remains under-investigated. Therefore, in this scoping review, we aimed to map the breadth and depth of evidence regarding post-operative mental health challenges faced by surgical patients. The review was conducted and reported in accordance with the Joanna Briggs Institute (JBI) methodology and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. A comprehensive search was conducted across PubMed, PsycINFO, Web of Science, the Cochrane Library, and gray literature sources. Of 29,536 studies initially identified, 86 primary research studies on adult populations where the primary outcomes were post-operative depression, anxiety, or post-traumatic stress disorder (PTSD) were included. Most studies were conducted in China (21) and the USA (14). Depression and anxiety symptoms were highly prevalent among patients; levels typically peaked during the early post-operative period before gradually improving, with some studies reporting prevalence rates of >60%. However, marked improvements in anxiety and depressive symptoms were observed following bariatric and corrective orthopedic surgeries. Notably, PTSD was more common among amputees and women undergoing cesarean deliveries. Our findings highlight a scarcity of evidence from low-income countries, as well as a lack of data on PTSD in patients undergoing urological or abdominal procedures other than cesarean sections. Additionally, marked heterogeneity in mental health assessment tools complicates the synthesis, interpretation, and comparison of data across studies. Large-scale, multinational studies are rare. In conclusion, post-operative depression, anxiety, and PTSD commonly occur after abdominal and orthopedic surgeries, and can significantly impair the quality of recovery and rehabilitation. Consequently, a multidisciplinary, patient-centered approach is essential to optimize surgical and mental health outcomes, ultimately ensuring the delivery of holistic patient care. Also, there is an urgent need to develop and harmonize mental health assessment tools for the post-surgical setting.