Psychological Complications in 281 Plastic Surgery Practices

Abstract

Surgery is a high-stakes stressor with possible consequences that include death, pain, disfigurement, economic losses, and alterations in social roles. Often, the most disturbing complications to surgeons and patients are psychological rather than physical. Ineffective management of psychological complications of surgery can have profound consequences, resulting in delayed recuperative times, delayed return to work, poor patient compliance, dissatisfaction with the surgical outcome, hostility toward surgeons, and anxiety. The purpose of this study was to investigate in a large randomized group of plastic surgery practices the relative incidence of negative psychological outcomes and to compare these with the incidence of adverse physical outcomes to gain a greater appreciation of the relative magnitude of each type of perioperative complication. The study design was a descriptive, correlational survey that assessed psychological complications reported by plastic surgeons. The Plastic Surgery Questionnaire was sent to 702 randomly selected 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 prevalent than physical problems such as hematoma or infection. Anxiety reactions were commonly encountered 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 commonly reported complications. Most surgeons (75.8 percent) reported that screening for depression was important, but only 18.8 percent identified screening for post-traumatic stress disorder as important, even though 86 percent had diagnosed post-traumatic stress disorder in their postoperative patients. Psychological complications occur at rates equal to or greater than those of physical complications in the plastic surgery practice. Patients who experience physical complications are much more likely to simultaneously experience psychological complications. Patients with preexisting psychological conditions are more at risk for postoperative psychological complications. Disappointment, anxiety, and depression were the most frequently seen psychological complications. Nursing personnel are perceived by plastic surgeons to have the primary role in screening patients for pertinent psychological history. Directed research should be undertaken to determine which treatment regimens are most effective in reducing preoperative psychological complications. Controlled clinical trials of” pharmaceuticals and alternative therapies must be designed and carried out in a prospective manner to establish the optimum treatment for alleviation of adverse emotional consequences of surgery. The next frontier for the specialty is to actively and consciously investigate and improve our patients' emotional and psychological results from surgery. (Plast. Reconstr. Surg. 104: 1241, 1999.)