Association of Postoperative Complication with Subsequent Mental Health Disorders: A Population-Based Study

Postoperative complication is associated with lower health-related quality of life, but its association with subsequent mental health disorders is less well understood. We examined whether 30-day postoperative complication was associated with new or worsening mental health disorders.

This population-based retrospective study included adults ≥18 years of age undergoing 1 of 25 common operations in Ontario, Canada, from January 2007 through December 2019. The primary outcome was new or worsening mental health disorders within 1 year, stratified by 30-day postoperative complication. Multivariable regression using generalized estimating equations adjusted for patient, provider, and procedural factors.

Among 1,165,711 patients (median age 60 years; 61.9% female), 5.0% developed new or worsening mental health disorders within 1 year. The rate was higher among patients with a complication (6.2% vs 4.9%; p < 0.001). Complication was associated with higher adjusted odds (aOR) of mental health disorders at 1 year (aOR 1.28; 95% CI 1.24 to 1.32), with the strongest association at 30 days (1.77; 1.65 to 1.90). At 1 year, the association was present among patients without prior mental health history (1.31; 1.17-1.46), but not among those with pre-existing history. Patients with complication also had more new psychiatrist consultations (3.2% vs 1.5%; 2.02; 1.69 to 2.42) and a higher rate of new psychotropic prescriptions. Findings were generally consistent across other time points.

Postoperative complication was associated with subsequent mental health disorders, specifically among patients without prior mental health history. These findings support the consideration of perioperative mental health surveillance.