Association of Postoperative Complication with Subsequent Mental Health Disorders: A Population-Based Study

BACKGROUND: Postoperative complication is associated with lower health-related quality of life, but its association with subsequent mental health disorders is less well understood. We examined whether 30-day postoperative complication was associated with new or worsening mental health disorders. STUDY DESIGN: This population-based retrospective study included adults ≥18 years of age undergoing 1 of 25 common operations in Ontario, Canada, from January 2007 through December 2019. The primary outcome was new or worsening mental health disorders within 1 year, stratified by 30-day postoperative complication. Multivariable regression using generalized estimating equations adjusted for patient, provider, and procedural factors. RESULTS: Among 1,165,711 patients (median age 60 years; 61.9% female), 5.0% developed new or worsening mental health disorders within 1 year. The rate was higher among patients with a complication (6.2% vs 4.9%; p < 0.001). Complication was associated with higher adjusted odds (aOR) of mental health disorders at 1 year (aOR 1.28; 95% CI 1.24 to 1.32), with the strongest association at 30 days (1.77; 1.65 to 1.90). At 1 year, the association was present among patients without prior mental health history (1.31; 1.17-1.46), but not among those with pre-existing history. Patients with complication also had more new psychiatrist consultations (3.2% vs 1.5%; 2.02; 1.69 to 2.42) and a higher rate of new psychotropic prescriptions. Findings were generally consistent across other time points. CONCLUSIONS: Postoperative complication was associated with subsequent mental health disorders, specifically among patients without prior mental health history. These findings support the consideration of perioperative mental health surveillance.