Impact of psychiatric disorders on surgical outcomes: A comprehensive review of preoperative screening and interventions

Abstract

Psychiatric disorders significantly impact surgical outcomes, presenting unique challenges in perioperative care. The intricate relationship between preoperative psychiatric conditions and surgical complications involves complex mechanisms, including altered coagulation, cardiovascular function, and pain perception. Common psychiatric disorders in surgical patients, such as anxiety, depression, and substance use disorders, vary in prevalence and manifestation. Demographic factors, comorbidities, and psychotropic medications further modulate these effects on surgical outcomes. Effective screening and assessment strategies are crucial, yet they present both opportunities and limitations in the preoperative setting. Preoperative psychological interventions, including cognitive-behavioral therapy, supportive care, and mind-body techniques, show promise in mitigating psychological distress and improving surgical outcomes. Multidisciplinary approaches, involving collaborative efforts between psychiatric and surgical teams, are essential to provide comprehensive patient care. Emerging interventions, technological innovations, and personalized medicine approaches offer exciting possibilities to advance preoperative psychiatric care. By understanding the complex interplay between psychiatric disorders and surgical outcomes, healthcare professionals can implement integrated, patient-centered approaches to optimize perioperative care and improve overall patient outcomes.

Key Words: Psychological interventions; Perioperative care; Mental health screening; Surgical risk assessment; Perioperative psychiatric management

Core Tip: Psychiatric disorders significantly influence surgical outcomes through mechanisms affecting coagulation, cardiovascular function, and pain perception. Effective preoperative screening and psychological interventions, such as cognitive-behavioral therapy and mind-body techniques, can reduce psychological distress and improve outcomes. Multidisciplinary collaboration between psychiatric and surgical teams, along with emerging personalized medicine approaches, is key to optimizing perioperative care and enhancing patient outcomes.

INTRODUCTION

The intersection of psychiatric disorders and surgical procedures represents a critical yet often overlooked aspect of modern healthcare. As surgical techniques continue to advance, there is a growing recognition of the profound impact that mental health of a patient can have on surgical outcomes. This relationship is bidirectional: Pre-existing psychiatric conditions can significantly affect surgical success, while the stress of surgery itself can exacerbate or even trigger mental health issues. Psychiatric disorders are remarkably prevalent in the general population, with an estimated one in four adults experiencing a diagnosable mental illness in any given year. Among surgical patients, this prevalence can be even higher, with some studies suggesting rates of up to 40% for conditions such as anxiety and depression. Despite this high prevalence, the impact of these disorders on surgical outcomes has historically been underappreciated.

The importance of addressing psychiatric disorders in the context of surgery cannot be overstated. Mental health conditions can influence a patient’s decision-making capacity, adherence to perioperative instructions, and postoperative recovery. Moreover, the physiological changes associated with psychiatric disorders, such as alterations in immune function and pain perception, can directly affect surgical risks and outcomes. Recent years have seen a growing body of research highlighting the need for a more integrated approach to perioperative care that addresses both physical and mental health needs. This shift toward holistic patient care has the potential to significantly improve surgical outcomes, enhance patient satisfaction, and reduce healthcare costs associated with complications and prolonged recovery times.

This article aims to provide a comprehensive overview of the complex relationship between psychiatric disorders and surgical outcomes. It explores the prevalence and impact of common psychiatric conditions in surgical patients, examines the mechanisms by which these disorders influence surgical success, and discusses current best practices for screening, assessment, and intervention. Furthermore, this article delves into the challenges and opportunities presented by the integration of psychiatric care into surgical practice. It highlights the importance of multidisciplinary collaboration and discusses emerging technologies and treatment modalities that hold promise for improving patient care. By shedding light on this critical intersection of mental health and surgery, this article seeks to equip healthcare professionals with the knowledge and insight necessary to provide truly comprehensive care to their patients. As the field of medicine continues to evolve toward more personalized and integrated approaches, understanding and addressing the psychiatric aspects of surgical care will become increasingly essential to achieve optimal patient outcomes.

METHODOLOGY

This review was conducted through a systematic search of PubMed, Scopus, Web of Science, and Google Scholar using MeSH terms and keywords related to the impact of psychiatric disorders on surgical outcomes. Articles published in English between 2002 and 2024 were considered. Inclusion criteria encompassed original research, systematic reviews, and meta-analyses focused on the impact of psychiatric disorders on surgical outcomes. We excluded case reports, editorials, conference abstracts, non-peer-reviewed sources, and studies on animal models or in vitro research without clinical relevance. Studies with insufficient methodological details or high bias risk were also excluded. Relevant findings were extracted and synthesized to present a comprehensive analysis of the impact of psychiatric disorders on surgical outcomes.

PSYCHIATRIC DISORDERS AND SURGERY

Psychiatric conditions, encompassing a range of disorders such as schizophrenia, depressive disorders, and anxiety disorders, are frequently observed in patients preparing for surgical interventions. Among these psychiatric disorders, anxiety disorders, particularly generalized anxiety disorder and panic disorder, are notably prevalent[1]. These conditions are characterized by excessive and debilitating anxiety, accompanied by fear and apprehension that surpass normative levels. Similarly, depressive disorders, including major depressive disorder (MDD) and dysthymia, are also commonly encountered in patients undergoing preoperative assessment. Individuals with depressive disorders typically exhibit persistent feelings of profound sadness, hopelessness, and a marked disinterest in previously pleasurable activities. Recognizing and thoroughly understanding these psychiatric conditions is essential to enhancing both the surgical process and postoperative outcomes for preoperative patients[2]. Preoperative psychiatric disorders present a notable concern among surgical patients, with prevalence rates varying according to the specific disorder in question[3]. Anxiety disorders are particularly prevalent, with reported rates ranging from 10% to 40% across different surgical cohorts[4]. Depression, including MDD and dysthymia, affects between 10% and 20% of individuals scheduled for surgery. Although less common, schizophrenia and other psychotic disorders still warrant significant attention due to their potential impact on surgical outcomes. The prevalence of preoperative psychiatric disorders can vary depending on sample characteristics, diagnostic criteria, and assessment methodologies. An in-depth understanding of these prevalence rates is crucial for the development of effective screening protocols, personalized treatment plans, and comprehensive perioperative care.

Several risk factors contribute to the emergence of perioperative psychiatric conditions. Patient-related factors include the history of psychiatric illness, previous episodes of anxiety or depression, a family history of psychiatric disorders[5], and inadequate social support. Additional risk factors encompass younger age, female gender[6], lower socioeconomic status, and certain personality traits such as neuroticism. Surgical factors also play a role; the complexity and invasiveness of the procedure, its duration, and anticipated postoperative pain can elevate the risk of psychiatric issues. Perioperative stressors, including uncertainty about surgical success, anxiety about general anesthesia, concerns about postoperative pain, and feelings of loss of control, significantly contribute to the onset or exacerbation of psychiatric disorders. Moreover, comorbid medical conditions, such as endocrine disorders, chronic pain, and cardiovascular diseases, can further interact with and heighten psychiatric risks. To effectively identify high-risk individuals, implement appropriate screening methods, and devise comprehensive perioperative care plans, it is essential to understand both the incidence rates and risk factors associated with perioperative psychiatric disorders. By proactively addressing these issues, healthcare professionals can mitigate the impact of psychiatric problems on surgical outcomes, enhance patient well-being, and promote more rapid postoperative recovery.

CLASSIFICATION AND DIAGNOSTIC CRITERIA

Preoperative psychiatric disorders are mental health conditions identified prior to undergoing surgical procedures. The diagnosis and classification of these disorders adhere to established psychiatric frameworks, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Clinicians typically assess patients through a comprehensive evaluation of their symptoms, medical history, and a detailed mental status examination to diagnose a preoperative psychiatric condition. The DSM-5 provides a robust framework to categorize mental disorders, offering precise criteria to assist clinicians in determining whether a patient meets the diagnostic thresholds for various conditions[7]. According to the DSM-5, anxiety disorders are characterized by pervasive and excessive worry, accompanied by symptoms such as irritability, fatigue, difficulty concentrating, restlessness, muscle tension, and disturbances in sleep. These symptoms must result in significant distress or functional impairment and cannot be exclusively attributed to the physiological effects of a medical condition or substance use. Similarly, depressive disorders are identified when an individual exhibits a persistently low mood, a marked loss of interest or pleasure in previously enjoyed activities, alterations in appetite or weight, sleep disturbances, fatigue, pervasive feelings of guilt or worthlessness, difficulties in concentration, and recurrent thoughts of death or suicide[8]. These symptoms must lead to considerable distress or interfere substantially with daily functioning over a specified duration.

Furthermore, substance use disorder is characterized by a maladaptive pattern of substance use leading to substantial distress or impairment. Diagnostic criteria include impaired control over substance use, social or occupational impairment, hazardous use, development of tolerance, withdrawal symptoms, and continued use despite adverse consequences. Psychotic disorders, such as schizophrenia or delusional disorder, are marked by symptoms including hallucinations, delusions, disorganized thinking, unusual motor behavior, and negative symptoms such as diminished emotional expression or social withdrawal. These symptoms must significantly impair social or occupational functioning and persist for a defined period. In addition to adhering to specific diagnostic criteria, clinicians also consider the patient’s history, the duration and severity of symptoms, and the potential impact of these conditions on the patient’s ability to safely undergo surgery. Accurate diagnosis and management of preoperative psychiatric disorders are essential to optimize patient outcomes and ensure appropriate perioperative care.

PSYCHIATRIC DISORDERS AND SURGICAL COMPLICATIONS

Psychiatric disorders may introduce distinctive challenges and elevate the risk of surgical complications. These complications often emerge from the complex interplay between mental health conditions and physiological factors affecting physical health. Patients with anxiety disorders, for instance, may experience exacerbated symptoms of anxiety and panic before surgery[9]. The physiological manifestations of anxiety, such as elevated heart rate, blood pressure, and respiratory rate, can heighten the risk of cardiovascular complications both intraoperatively and postoperatively[10]. Excessive anxiety may also complicate the anesthetic induction process, potentially leading to issues such as airway management difficulties or inadequate sedation[11]. Additionally, heightened anxiety can adversely affect postoperative recovery and delay wound healing, attributable to elevated levels of stress hormones[12]. Similarly, depression can profoundly affect a patient’s physical health and recovery capacity[13].

Individuals suffering from depression often exhibit reduced motivation, energy, and self-care abilities[14]. Consequently, they may not adhere as rigorously to preoperative directives, such as dietary restrictions and medication regimens, potentially leading to surgical complications such as infections or delayed wound healing[15]. Additionally, depression is associated with cognitive impairments that can impact decision-making processes, comprehension of postoperative instructions, and adherence to prescribed medications[16]. For patients with substance use disorders, complications arise from both their physical health and substance abuse[17]. Chronic substance abuse can induce dysfunctions in cardiovascular, respiratory, and hepatic systems, thereby elevating the risk of complications associated with anesthesia, bleeding, and infections[18]. Furthermore, substance use disorders may lead to drug interactions or inadequate pain management, as individuals often develop increased tolerance to analgesics or resort to additional substances for pain relief[19]. Furthermore, due to nutritional deficiencies and compromised immune function, substance addiction can adversely affect postoperative recovery and delay wound healing[20].

Patients with psychotic disorders, such as schizophrenia, also face specific challenges in the surgical context[21]. Symptoms of psychosis, including hallucinations and delusions, can lead to confusion, agitation, and difficulties in communication[22]. These issues may complicate the process of anesthesia induction, and patients may struggle with cooperation or exhibit heightened irritability. Additionally, individuals with psychotic disorders may experience significant difficulties in understanding and adhering to postoperative directives related to pain management, wound care, and activity restrictions. These challenges can increase the likelihood of complications and hinder the overall healing process[23]. Furthermore, individuals with eating disorders, such as anorexia nervosa or bulimia nervosa, face unique challenges due to irregular eating patterns and compromised physical health[24]. These disorders can result in severe nutritional deficiencies, electrolyte imbalances, and cardiovascular abnormalities[25]. Furthermore, the psychological impacts of eating disorders, including distorted body image perceptions and preoccupation with weight, may contribute to difficulties with postoperative nutritional management, noncompliance with dietary restrictions, and increased psychological distress following surgery[26].

Patients with bipolar disorder may face significant challenges during the perioperative period due to mood fluctuations, medication management, and disrupted sleep patterns[27]. Those experiencing manic episodes may exhibit impulsive behavior, potentially impacting decisions related to surgical interventions or postoperative care. Conversely, depressive episodes can result in diminished motivation, energy levels, and self-care capabilities, which may hinder adherence to preoperative and postoperative instructions[28]. Additionally, careful monitoring of medications is essential, as mood stabilizers or antipsychotics used in the treatment of bipolar disorder may interact with anesthetic agents or other medications administered during surgery[29].

LINKING PSYCHIATRIC DISORDERS TO SURGICAL OUTCOMES

Psychiatric conditions can significantly influence surgical outcomes through a complex interplay of clinical, psychological, and physiological factors. One significant aspect is the impact on coagulation and clotting mechanisms. Certain psychiatric conditions, including anxiety and depression, have been associated with alterations in coagulation factors and platelet function[30]. These changes can elevate the risk of thrombotic events or bleeding complications both during and after surgical procedures. Another critical factor is the effect of psychiatric disorders on cardiovascular function. Conditions such as depression, bipolar disorder, and anxiety disorders are linked with cardiovascular dysregulation, which may manifest as heightened sympathetic activity, altered heart rate variability, or endothelial dysfunction[31]. Such cardiovascular abnormalities can predispose individuals to complications during surgery, impacting overall outcomes. Additionally, psychiatric conditions can alter pain processing and perception. Disorders like depression, anxiety, and somatoform disorders may increase pain sensitivity, impair pain modulation, and reduce the efficacy of analgesic medications. Inadequate pain management can lead to prolonged hospital stays, delayed recovery, and an increased risk of postoperative complications[32]. Furthermore, substance use disorders, which frequently co-occur with psychiatric illnesses, can significantly affect surgical outcomes[33]. Substance abuse can modify anesthetic requirements, alter drug metabolism, increase the risk of adverse drug reactions, and complicate postoperative pain management. Perioperative withdrawal symptoms can exacerbate physiological stress and contribute to adverse outcomes[34]. Psychiatric conditions also disrupt sleep patterns, such as insomnia, sleep apnea, or mood disorders, which can impair immune function, exacerbate inflammation, and hinder wound healing, leading to additional surgical complications[35]. Neurocognitive impairments associated with psychiatric disorders like schizophrenia and bipolar disorder can impact decision-making abilities, comprehension of surgical instructions, and medication adherence, potentially increasing complication risks[36]. Lastly, psychiatric disorders can disrupt social support networks, leading to inadequate postoperative care, compromised recovery, and heightened risk of complications, further exacerbating psychological distress and impairing overall surgical outcomes[37].

The presence of psychiatric disorders often disrupts adherence to preoperative and postoperative care regimens, impairs immune function, and undermines the body’s ability to manage surgical stress, all of which contribute to adverse outcomes[38]. Furthermore, psychiatric disorders can compromise a patient’s decision-making capacity, particularly concerning the informed consent process for surgical procedures[39]. Conditions such as schizophrenia, bipolar disorder, or severe anxiety may affect judgment, cognitive function, and the ability to weigh the risks and benefits of surgery appropriately[40]. This impaired decision-making can lead to suboptimal treatment choices, which may negatively impact surgical results[41]. Additionally, psychiatric medications commonly prescribed for conditions such as schizophrenia, bipolar disorder, and depression may interact with anesthetics and other perioperative medications[42]. These interactions can modify the effects of anesthesia, alter drug metabolism, or lead to adverse reactions, making it critical to thoroughly assess the pharmacokinetic and pharmacodynamic properties of psychiatric medications to ensure optimal dosing and minimize complications[43]. Moreover, patients with psychiatric disorders often require specialized considerations during anesthesia administration[44]. Conditions like substance use disorders or chronic pain with co-occurring psychiatric issues may influence both the need for and response to anesthesia[45]. Individuals with anxiety or post-traumatic stress disorder might be more vulnerable to the stress associated with surgery, necessitating tailored anesthetic management to enhance outcomes[46]. Moreover, the psychological impact of surgery, which can be intensified in those with pre-existing psychiatric conditions, may manifest as postoperative depression, anxiety, or trauma symptoms[47]. These effects can impair recovery, exacerbate pain, complicate adherence to treatment regimens, and prolong hospital stays[12]. Addressing the psychological impact through comprehensive screening, management, and support can lead to improved postoperative outcomes[23]. Finally, the presence of psychiatric comorbidities often results in increased healthcare utilization, including more frequent emergency department visits, higher rates of hospital readmissions, and extended hospitalizations[48], which in turn drive up medical costs and resource consumption[49].

Demographic factors, psychiatry, and surgery

The interplay of demographic factors such as age, gender, socioeconomic status, educational attainment, and cultural background significantly influences the impact of preoperative psychiatric conditions on surgical outcomes. Age is a critical factor, as older individuals may face distinct challenges and outcomes compared to younger patients[50]. Age-related physiological changes, such as reduced organ function and slower healing processes can interact with pre-existing psychiatric disorders, thereby affecting surgical results in various ways. Additionally, gender disparities have also been observed in the context of preoperative mental disorders[51] and surgical outcomes. Research indicates that women might be more susceptible to the adverse effects of certain psychological states on postoperative recovery[3,52]. Although the exact mechanisms behind these gender differences are not fully elucidated, hormonal and metabolic factors, along with variations in coping strategies and social support, may contribute to these findings. Moreover, in addition to age and gender, other demographic factors such as socioeconomic status, educational attainment, and cultural background play significant roles in the prevalence and impact of preoperative psychiatric conditions on surgical outcomes[53]. Socioeconomic status and educational level can influence access to medical care, social support, and overall resilience, with lower socioeconomic[54] or educational levels, potentially leading to suboptimal preoperative care and follow-up, which may adversely affect surgical outcomes[55].

Cultural context is another crucial element to consider[56]. Patients from diverse cultural backgrounds may have differing beliefs, attitudes, and behaviors regarding mental health and surgical interventions. These cultural factors can affect how patients perceive and manage preoperative psychiatric issues and their interactions with healthcare providers[57,58]. Addressing and integrating cultural considerations into medical care is essential to provide effective treatment and support to patients from varied backgrounds[59-61]. Overall, age, gender, socioeconomic status, educational level, and cultural background are significant demographic variables that can influence the relationship between preoperative psychiatric disorders and surgical complications. Recognizing and accommodating these factors in clinical practice can enhance surgical outcomes and overall patient well-being.

The severity and duration of preoperative psychiatric disorders play a crucial role in determining the risk of surgical complications. The severity and duration of preoperative psychiatric conditions can significantly influence the risk of surgical complications. Patients with severe and chronic psychiatric disorders are at an elevated risk for adverse surgical outcomes[62,63]. Additionally, the presence of multiple concurrent psychiatric conditions can exacerbate symptom complexity and intensity, further increasing the likelihood of unfavorable surgical results. Consequently, it is essential for healthcare professionals to assess the severity and duration of preoperative mental health issues to accurately gauge potential risks and tailor interventions accordingly[64,65]. Patients exhibiting more severe psychiatric symptoms may necessitate enhanced psychiatric support and close monitoring throughout the surgical procedure[66,67].

Moreover, the interplay between multiple physical disorders[68] and preoperative psychological conditions[69,70] can significantly affect surgical outcomes. Patients with comorbidities—multiple concurrent medical conditions—may experience an exacerbated impact of mental health issues on surgical complications[71]. Chronic conditions such as diabetes[72], cardiovascular disease[73], and obesity[74] can complicate the surgical process and increase the likelihood of adverse outcomes. Therefore, effective management of chronic comorbidities requires a coordinated approach involving a multidisciplinary team, including both surgical and psychiatric care providers. Addressing both the psychological and medical dimensions of patient care is essential to optimize surgical outcomes for individuals with concurrent medical issues[75].

The influence of psychotropic medications on surgical outcomes is a critical consideration in preoperative mental health management. The administration of these medications for preoperative mental health management can significantly impact surgical outcomes. For instance, selective serotonin reuptake inhibitors (SSRIs) have been associated with an increased risk of bleeding and delayed wound healing[76,77]. These effects are particularly concerning in surgeries involving extensive tissue damage, such as cardiac, orthopedic, or neurosurgical procedures. Additionally, benzodiazepines, frequently prescribed for anxiety and insomnia, can affect both respiratory and cardiovascular systems, raising the risk of postoperative complications including hypoxia, hypotension, and delirium[78,79]. Furthermore, these medications may interact with other perioperative drugs, such as opioids and muscle relaxants, potentially leading to excessive sedation, respiratory depression, and prolonged recovery[80]. Consequently, healthcare providers must carefully weigh the risks and benefits of continuing or discontinuing psychiatric medications around the time of surgery. Collaboration between psychiatrists and surgeons is essential to ensure optimal management of psychiatric symptoms while minimizing surgical risks. For instance, tapering or discontinuing SSRIs before surgery might mitigate bleeding and wound healing issues[81]; however, this approach could also increase the risk of relapse or withdrawal symptoms in patients with depression or anxiety[82]. Thus, decisions regarding SSRIs should be individualized based on the patient’s condition, the specifics of the surgical procedure, and the availability of alternative treatments. Similarly, the use of benzodiazepines should be carefully reviewed and adjusted based on the patient’s needs and response[79] (Table 1).

Table 1 Linking psychiatric disorders to surgical outcomes.

Psychiatric disorder	Prevalence in surgical patients	Associated surgical complications	Mechanisms involved
Anxiety disorders	10%-40% across different surgical cohorts	Cardiovascular complications, airway management difficulties, inadequate sedation, delayed wound healing	Elevated heart rate, blood pressure, respiratory rate, elevated stress hormones
Depression	10%-20% of individuals scheduled for surgery	Reduced adherence to preoperative directives, infections, delayed wound healing, cognitive impairments affecting decision-making	Reduced motivation, energy, self-care abilities, cognitive impairments
Substance use disorders	Commonly encountered (specific percentage not stated)	Drug interactions, inadequate pain management, anesthesia complications, bleeding, infections, delayed wound healing	Cardiovascular, respiratory, and hepatic dysfunctions, increased tolerance to analgesics, nutritional deficiencies, compromised immune function
Psychotic disorders	Less common but warrant significant attention	Confusion, agitation, communication difficulties, cooperation issues during anesthesia induction, difficulties with postoperative directives	Hallucinations, delusions, confusion, agitation, communication difficulties
Bipolar disorder	Significant challenges during perioperative period	Impulsive behavior affecting decisions, diminished motivation impacting care adherence, medication interactions	Mood fluctuations (manic/depressive episodes), disrupted sleep patterns, medication interactions with anesthetics
Eating disorders	Present unique challenges (prevalence not specified)	Severe nutritional deficiencies, electrolyte imbalances, cardiovascular abnormalities, difficulties with postoperative nutritional management	Irregular eating patterns, nutritional deficiencies, distorted body image perceptions, preoccupation with weight

SCREENING AND ASSESSMENT STRATEGIES

The identification of preoperative psychological issues is essential to ensure that patients receive the necessary support and intervention prior to surgery[80-83]. Various readily accessible methods are available for detecting the presence and intensity of mental health disorders. Among these, the Hospital Anxiety and Depression Scale is one of the most commonly employed screening instruments[84,85]. It is instrumental in identifying symptoms of depression and anxiety. Additionally, the Generalized Anxiety Disorder 7-item scale is specifically designed for the assessment of anxiety[86]. Another valuable tool is the Patient Health Questionnaire-9, which is frequently utilized to evaluate depressive symptomatology[87]. These concise screening instruments provide critical insights into a patient’s psychological well-being, enabling healthcare providers to ascertain the presence and severity of mental health concerns in preoperative patients. Such assessments allow medical professionals to promptly evaluate an individual’s mental health status and determine the need for further support.

In addition to screening methods, comprehensive evaluations are essential to assess the severity of preoperative mental health issues and their impact on overall patient well-being[88]. These detailed assessments involve clinical interviews, self-report questionnaires, and supplementary information from family members or healthcare providers. Such evaluations enable psychiatrists and psychologists to acquire a nuanced understanding of the patient’s psychological history, the nature and severity of their symptoms, the extent to which these symptoms affect their daily functioning, and their coping mechanisms. This thorough approach provides a holistic view of the patient’s mental health and informs the determination of the appropriate level of intervention and support tailored to their specific needs. Clinical interviews offer patients the opportunity to candidly discuss their mental health concerns, emotions, and experiences[89]. Self-report questionnaires deliver systematic analyses focusing on the core aspects of a patient’s symptoms and overall mental health[90]. Additional insights from family members or healthcare professionals further enrich the understanding of the patient’s condition. By synthesizing data from these diverse evaluations, medical experts can gain a more comprehensive understanding of the patient’s psychological status. This integrated information serves as a foundation for developing personalized treatment and support plans that address the unique needs of each patient.

CHALLENGES AND LIMITATIONS

Acknowledging the inherent challenges and limitations associated with screening and assessment methodologies is essential for the accurate identification of psychiatric disorders in the preoperative setting. Despite their critical role in identifying psychiatric disorders prior to surgery, it is crucial to recognize the limitations inherent in screening and evaluation methods. Self-report questionnaires, while useful, may be subject to biases such as patients’ preconceptions or a propensity to provide socially desirable responses. Consequently, the reliability of these findings may be compromised, potentially leading to inaccurate symptom reporting[91]. Additionally, linguistic and cultural barriers can pose challenges in implementing screening tools, as they may not fully capture the diverse experiences of different patient populations[92]. Furthermore, time constraints and limited resources within healthcare settings present further obstacles. Due to these constraints, it may be difficult to provide each patient with a thorough evaluation[93]. Healthcare professionals often face the need to balance comprehensive assessments with the practical limitations of time and budget, which may necessitate prioritizing certain patients or issues over others. Therefore, it is essential for healthcare providers to acknowledge these limitations of screening and assessment methods, recognizing that while these tools are valuable, they should be integrated into a broader framework that includes clinical judgment, consideration of the patient’s unique context, and ongoing communication with the patient. By understanding these challenges and constraints, healthcare professionals can optimize the use of screening and assessment tools, thereby enhancing the quality of care provided to patients.

PERIOPERATIVE PSYCHOLOGICAL INTERVENTIONS

Perioperative psychological interventions play a crucial role in mitigating mental health symptoms and enhancing surgical outcomes[94]. Among these, cognitive-behavioral therapy (CBT) is an established method for alleviating anxiety and depression in patients preparing for surgery. CBT focuses on identifying and modifying negative thought patterns and behaviors that contribute to psychological distress[95]. Additionally, relaxation techniques such as deep breathing exercises and progressive muscle relaxation are valuable tools for managing preoperative anxiety and tension. These methods enable patients to achieve a state of relaxation and reduce preoperative stress[96]. Moreover, mindfulness-based therapies also show promise in this context. These interventions, which include practices like meditation and guided imagery, have been demonstrated to effectively decrease preoperative anxiety and enhance overall surgical outcomes.

CBT significantly reduces the likelihood of postoperative complications by fostering adaptive behaviors and eliminating maladaptive coping strategies. By enhancing patients’ communication skills, problem-solving abilities, and self-confidence, CBT aims to improve surgical outcomes[97]. For CBT to be effective, it must address and correct cognitive distortions and detrimental thought patterns. These therapies help patients develop more realistic and positive expectations regarding their surgical experience, which can reduce preoperative anxiety by providing a clearer understanding of what to anticipate[98]. Moreover, patients who undergo CBT may exhibit improved pain management and adherence to postoperative care instructions. In essence, CBT facilitates the adoption of more constructive and realistic attitudes toward surgery. This approach enables patients to manage pain more effectively, experience reduced anxiety, and comply better with postoperative self-care recommendations, thereby potentially decreasing the risk of surgical complications. In addition to CBT, supportive care plays a crucial role in postoperative recovery by providing emotional encouragement and empathy to patients. In practice, such support can facilitate a more rapid recovery following surgery. When patients have access to a trusted and empathetic therapist, they can openly express their concerns and difficulties in a supportive environment[99]. Supportive care is advantageous as it helps patients navigate the psychological challenges associated with surgery, potentially leading to improved overall well-being and reduced discomfort. By addressing the social and emotional needs of patients, supportive care may enhance recovery speed[100]. In essence, supportive care involves having a reliable presence to offer emotional support. This support allows patients to articulate their surgical anxieties and concerns, which can lead to a greater sense of comfort and reduced apprehension. The focus on addressing emotional needs through supportive care can thereby contribute to a more expedited postoperative recovery.

The utilization of mind-body interventions, such as yoga and guided visualization, effectively reduces preoperative stress and anxiety among patients preparing for surgical procedures. These relaxation modalities incorporate physical movement, deep breathing, and focused concentration to facilitate tension release and promote emotional decompression[101-103]. Engagement in these mind-body therapies may assist patients in achieving a state of calm and inner tranquility, potentially leading to decreased preoperative anxiety. The therapeutic emphasis on the mind-body interface holds the potential not only to enhance surgical outcomes but also to contribute positively to overall health. Consequently, mind-body therapies, including practices such as yoga, tai chi, and guided meditation, are utilized to induce a sense of peace and reduce anxiety in the preoperative period. These interventions encompass physical movement, respiratory exercises, and attention-focused techniques aimed at fostering inner serenity and overall well-being. By implementing these strategies, patients may experience improved emotional state and smoother procedural experiences.

MULTIDISCIPLINARY APPROACHES

Effective collaboration between psychiatrists and surgeons is essential to deliver comprehensive care to patients with psychiatric conditions in the perioperative context[104]. Psychiatrists play a pivotal role in identifying and managing psychiatric disorders, offering effective therapeutic interventions, and guiding surgeons on strategies to address mental health challenges during surgical procedures[105]. This multidisciplinary approach extends throughout the perioperative phase, involving continuous communication, shared information, and joint decision-making to optimize clinical outcomes[106]. Surgeons rely on the expertise of psychiatrists to provide critical insights into the patient’s psychological status, ensuring that tailored interventions are in place to promote both mental and physical well-being during surgery[107]. Furthermore, interdisciplinary healthcare, involving a diverse team of professionals, exerts a significant impact on surgical outcomes for patients with pre-existing psychiatric conditions[104]. This approach integrates expertise from multiple disciplines, including psychiatry, surgery, nursing, and social work, with the goal of delivering holistic care[105]. A team-based strategy ensures that patients receive comprehensive support that addresses their physical, emotional, and social needs. Through the collaborative efforts of the healthcare team, communication, coordination, and overall patient outcomes are markedly improved[106]. By leveraging the specialized knowledge of each team member, patients benefit from an individualized treatment plan that considers their unique clinical and psychosocial circumstances, thereby promoting enhanced overall well-being[107].

Effective communication and collaboration between psychiatric and surgical teams are essential to deliver optimal care to patients with psychiatric disorders prior to surgery. To facilitate this, regular meetings[108], case conferences, and opportunities for shared decision-making are highly advantageous[109]. These strategies ensure a continuous flow of information and confirm that the psychiatric needs of the patient are comprehensively addressed throughout the surgical process. To promote teamwork and reduce the likelihood of misunderstandings, it is imperative to establish clear communication pathways and delineate the specific roles and responsibilities of each team member. Additionally, the integration of electronic medical records and advanced communication technologies can significantly enhance inter-team coordination. This approach enables seamless information exchange and provides immediate updates regarding patient care[110]. Furthermore, a growing body of research provides critical insights into the effective application of multidisciplinary strategies in preoperative psychiatric care. For example, one investigation revealed that the integration of preoperative psychiatric assessment and intervention into the clinical management of specific patients can yield substantial benefits[111]. Another study highlighted that patients with arthritis and fibromyalgia would gain from a holistic approach that encompasses psychiatric support[112]. Likewise, research focusing on the older adult population indicated that a well-coordinated multidisciplinary preoperative evaluation can significantly decrease complications and shorten hospital stays[113]. Moreover, the adoption of a comprehensive multidisciplinary preoperative strategy was found to markedly improve postoperative outcomes and adherence to follow-up protocols, as demonstrated by another study[114]. Additionally, findings suggested that the use of antidepressant and anxiolytic medications correlates with extended postoperative hospitalizations[115], underscoring the need for enhanced perioperative support to promote expedited recovery. Finally, a related study underscored that psychiatric evaluation and consensus should be regarded as prerequisites prior to surgical intervention[116].

FUTURE DIRECTIONS

The evolution of preoperative psychiatric care is marked by continual advancements in knowledge and treatment approaches. Future research may aim to elucidate the underlying mechanisms linking preoperative psychiatric disorders to surgical complications, as well as to identify novel interventions designed to improve patient outcomes[117]. Technological innovations, such as telemedicine and digital health solutions, could also play a significant role in enhancing access to preoperative psychiatric care[118]. Virtual interventions and remote monitoring can provide essential support to patients, particularly those living in underserved areas or experiencing mobility challenges[119]. Furthermore, the landscape of preoperative psychiatric care is being transformed by innovative interventions and treatment modalities that have the potential to improve surgical outcomes[120]. For example, virtual reality-based interventions have shown promise in reducing preoperative anxiety and improving pain management[121]. Non-pharmacological approaches, such as transcranial magnetic stimulation, may also be investigated as adjunctive treatments for preoperative psychiatric disorders[122]. Additionally, personalized medicine strategies, including pharmacogenomics, could facilitate the selection of psychotropic medications, optimizing their effectiveness while minimizing adverse effects[123]. These emerging interventions and treatment modalities have the capacity to transform preoperative psychiatric care and significantly enhance patient outcomes[124].

To achieve effective preoperative psychiatric care, a thorough and systematic approach is essential. Successful strategies include the integration of psychiatric screenings into standard preoperative assessments, promoting interdisciplinary collaboration, and establishing evidence-based guidelines and protocols[125,126] (Table 1).

CONCLUSION

The management of psychiatric disorders in surgical contexts is critical to optimize preoperative care. Pre-existing psychiatric conditions significantly impact surgical outcomes, necessitating comprehensive, multidisciplinary approaches. Effective screening, assessment, and intervention strategies are crucial to identify and address psychiatric issues before surgery. Integrating psychiatric care into surgical practice improves patient outcomes while enhancing overall healthcare quality and cost-effectiveness. Technological advancements, personalized medicine, and novel therapeutic interventions hold promise for further improving preoperative psychiatric care. Ongoing research and interdisciplinary collaboration are essential for developing evidence-based guidelines and optimizing patient-centered care. Prioritizing the mental health of surgical patients can significantly enhance surgical success rates, patient satisfaction, and overall well-being throughout the surgery. We recommend integrating psychiatric screenings into preoperative assessments, leveraging emerging interventions like telemedicine and personalized medicine, and enhancing interdisciplinary collaboration to optimize surgical outcomes and improve patient care.