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Nonfatal self-injury in the first year after surgery: a population-based epidemiologic study
Calvin Diep1, Julian F Daza2, Sandra Lee3
1Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
British Journal of Anaesthesia
|January 23, 2026
Summary
Surgery recovery can cause distress, increasing suicide risk. Nonfatal self-injury (NFSI) occurred in 7.07 per 10,000 patients post-surgery, higher than PCI or cataract procedures.
Area of Science:
- Medical research
- Public health
- Surgical outcomes
Background:
- Post-surgical recovery presents psychological challenges.
- Patients undergoing surgery are at risk for suicidal behaviors, including nonfatal self-injury (NFSI).
- This study investigates the incidence and risk factors for NFSI following surgical procedures.
Purpose of the Study:
- To determine the incidence of nonfatal self-injury (NFSI) after surgery.
- To identify patient and surgery-related factors associated with NFSI.
- To compare NFSI incidence in surgical patients with those undergoing percutaneous coronary interventions and cataract procedures.
Main Methods:
- Utilized linked administrative databases from New York state (2016-2018).
- Included adults (≥18 years) undergoing various surgical procedures.
- Employed doubly robust estimation and Cox models to analyze outcomes and risk factors.
Main Results:
- Identified 824 cases of NFSI among 1,165,881 patients within one year post-surgery (incidence 7.07 per 10,000).
- NFSI incidence was significantly higher compared to percutaneous coronary interventions (4.88 per 10,000) and cataract procedures (1.52 per 10,000).
- Risk factors included younger age, White race, lower income, rural residence, prior psychiatric history, and nonelective surgery.
Conclusions:
- Certain patient demographics and conditions increase susceptibility to post-surgical NFSI.
- Administrative data may underestimate the full extent of suicidal behaviors and psychological distress after surgery.
- Further research using validated instruments is recommended to assess psychological distress post-surgery.
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