The average person will undergo nine surgical procedures in his or her lifetime, and the periods before, during and after surgery are considered high risk regarding mental health, particularly among older adults. Depression and anxiety are especially common in older surgery patients; past research has demonstrated that about 40% of older surgical patients have mental health difficulties that can affect their quality of life and hinder recovery after an operation.
Identifying and treating depression and anxiety in surgical patients is the goal of a team of clinicians and researchers at Washington University School of Medicine in St. Louis. The team has received a four-year, $6.2 million grant from the National Institute of Mental Health of the National Institutes of Health (NIH) to launch a center designed to help improve mental health in surgery patients.
The new Center for Perioperative Mental Health is the first NIH-funded center of its kind in the United States. The center will conduct clinical trials, initially involving three types of surgery: joint replacement, and cardiac and cancer surgery. Led by scientists from psychiatry, anesthesiology, general surgery, orthopedic surgery and the university’s Institute for Informatics, the center’s purpose is to protect and improve the mental health of patients during the stressful spans just before, during and after an operation, with a particular focus on older adults.
“More older adults are having surgery than ever before, and the rates of clinically significant depression and anxiety are about four times higher among those having surgery than among older adults who are not,” said Eric J. Lenze, MD, the Wallace and Lucille K. Renard Professor of Psychiatry and one of the center’s co-principal investigators. “This new center is designed to allow clinicians and scientists to collaborate to prevent adverse mental health outcomes in older people who need surgery.”
Every year, some 50 million people in the United States — and 350 million worldwide — have surgery. Those operations can be life-changing events.
Older surgery patients in particular face challenging hospital stays, often followed by stints in rehabilitation facilities and then home visits from nurses and therapists. Lenze said the upheaval caused by an operation, frequent changes in location after surgery, and interactions involving medications can contribute to cognitive decline, confusion and issues with a patient’s mood.
The whole process can be overwhelming for patients, according to the center’s other principal investigator, Michael S. Avidan, MBBCh, the Dr. Seymour and Rose T. Brown Professor and head of the Department of Anesthesiology. He said the increasing awareness that mental health contributes to better overall health outcomes for surgery patients is a key reason he and Lenze worked to form the new center.
“People are much more than the body parts they have repaired during surgery, much more than heart valves or arthritic joints,” Avidan said. “Our plan with this center is to deal with patients holistically and to address factors that affect health and wellness. Although ours is a center focusing on mental health, we see our role in a much broader context, with overall patient wellness as the goal.”