Virginia Anesthesia Services LLC Link Between General Health and Surgery Outcomes - Virginia Anesthesia Services

Link Between General Health and Surgery Outcomes 

General health factors such as age, preexisting medical conditions, and lifestyle habits can significantly impact the outcomes of surgery. Older adults and individuals with chronic medical conditions are at higher risk of complications during and after surgery. Additionally, lifestyle habits such as smoking, excessive alcohol consumption, and poor nutrition can increase the risk of complications and delay the healing process; the link between general health and surgery outcomes is strong.  

In medical literature, the relationship between advanced age and an increased risk of postoperative complications has been well-established. However, emerging research indicates that age itself is not a direct indicator of increased risk. Rather, frailty, an age-related factor that measures accumulative decline in general health, is a better predictor of a patient’s level of risk for and link to poorer outcomes after surgery (3). Patients can be assessed on a frailty index before surgery to determine their level of risk, enabling surgeons to more accurately counsel them (2). 

The number and severity of comorbid conditions also significantly impact a patient’s risk of morbidity and mortality. For instance, diabetics who have poor control over their blood sugar suffer from an increased risk of infection and delayed wound healing (1). Patients with heart failure may also be at a greater risk of postoperative complications and mortality after ambulatory surgery (3). 

Lifestyle factors and mental health also cannot be overlooked when assessing a patient’s level of risk. Patients who consume alcohol excessively experience an increased risk of bleeding and cardiopulmonary complications, as well as an increased risk of mortality by two to three-fold (2). Smokers also are at risk of surgical complications such as longer wound healing times and heart attacks (1). Anxiety, depression, and perception of pain may also impact the level of pain a patient experiences postoperatively and the length of their hospital stay (5). 

In order to improve surgery outcomes, the clinical team needs to accurately assess a patient’s holistic, general health, including aspects of their mental health. Educating patients on the requirements for discharge and incorporating rehabilitation programs that prepare patients for the physiological stress of surgery have been demonstrated to contribute to faster recovery times (2). In many cases, furthermore, general health factors are tied to a patient’s social determinants of health, including their socioeconomic status, level of education, and access to high-quality medical care (1). As a result, improving social determinants of health for marginalized populations directly contributes to improving postoperative outcomes. 

References 

  1. Fox, Matthew. “Social determinants of health and surgery: An overview.” American College of Surgeons, 4 May 2021, bulletin.facs.org/2021/05/social-determinants-of-health-and-surgery-an-overview/ 
  1. Lee, Sung Gon and Andrew Russ. “Predicting and Preventing Postoperative Outcomes.” Clinics in Colon and Rectal Surgery, vol. 31, no. 3, 2019, pp. 149-156, doi:10.1055/s-0038-1677001 
  1. Lerman, Benjamin J et al. “Association Between Heart Failure and Postoperative Mortality Among Patients Undergoing Ambulatory Noncardiac Surgery.” JAMA Surgery, Oct 2019, vol. 154, no. 10, pp. 907-914. doi: 10.1001/jamasurg.2019.2110 
  1. Lin, Hui-Shan. “Frailty and post-operative outcomes in older surgical patients: a systematic review.” BMC Geriatrics, vol. 16, no. 157, 2016, https://doi.org/10.1186/s12877-016-0329-8 
  1. Mennig, Eva F et al. “The relationship between pre-surgery self-rated health and changes in functional and mental health in older adults: insights from a prospective observational study.” BMC Geriatrics, vol. 23, no. 203, 2023, https://doi.org/10.1186/s12877-023-03861-x 
  1. Richard, Heather M et al. “Preoperative mental health status is a significant predictor of postoperative outcomes in adolescents treated with hip preservation surgery.” Journal of Children’s Orthopaedics, vol. 14, no. 4, 2020, https://doi.org/10.1302/1863-2548.14.2000