Psychological complications in 281 plastic surgery practices

Surgery is a high-stakes stressor with possible consequences that include d eath, pain, disfigurement, economic losses, and alterations in social roles . Often, the most disturbing complications to surgeons and patients are psy chological rather than physical. Ineffective management of psychological co mplications of surgery can have profound consequences, resulting in delayed recuperative times, delayed return to work, poor patient compliance, dissa tisfaction with the surgical outcome, hostility toward surgeons, and anxiet y. The purpose of this study was to investigate in a large randomized group of plastic surgery practices the relative incidence of negative psychologi cal outcomes and to compare these with the incidence of adverse physical ou tcomes to gain a greater appreciation of the relative magnitude of each typ e of perioperative complication. The study design was a descriptive, correl ational, survey that assessed psychological complications reported by plast ic surgeons. The Plastic Surgery Questionnaire tvas sent to 702 randomly se lected board-certified plastic surgeons. The sample consisted of 281 board- certified plastic surgeons (40 percent response rate). The study instrument was found to be highly reliable, with inter-item Cronbach's alpha r = 0.85 . The demographics were representative of the specialty as a whole. It was found in general that psychological complications were much more pre valent than physical problems such as hematoma or infection, Anxiety reacti ons were commonly encounter ed by 95.4 percent of surgeons; disappointment (96.8 percent), depression (95.0 percent), nonspecific physical complaints (92.2 percent), and sleep disorders;(88.5 percent)were the next most common ly reported complications. Most surgeons (75.8 percent) reported that scree ning for depression was important, but only 18.8 percent identified screeni ng for post-traumatic stress disorder as important, even though 86 percent had diagnosed post-traumatic stress disorder in their postoperative patient s. Psychological complications occur at rates equal to or greater than thos e of physical complications in the plastic surgery practice. Patients who e xperience physical complications are much more likely to simultaneously exp erience psychological complications. Patients with preexisting psychologica l conditions are more at risk for postoperative psychological complications . Disappointment, anxiety, and depression were the most frequently seen psy chological complications. Nursing personnel are perceived by plastic surgeo ns to have the primary role in screening patients for pertinent psychologic al history. Directed research should be undertaken to determine which treat ment regimens are most effective in reducing preoperative psychological com plications. Controlled clinical trials of pharmaceuticals and alternative t herapies must be designed and carried out in a prospective manner to establ ish the optimum treatment for alleviation of adverse emotional consequences of surgery. The next frontier for the specialty is to actively and conscio usly investigate and improve our patients: emotional and psychological resu lts from surgery.