The Influence of Elective Surgery on Functional Health in Veterans with PTSD

Post-traumatic stress disorder (PTSD) affects 9%-43% of veterans and has been associated with greater mortality after elective inpatient surgery.  The perioperative course of veterans with PTSD is unclear, as patients with preexisting PTSD are underrepresented in studies of perioperative outcomes.  The majority of elective surgeries are conducted on outpatients, and no study to date has prospectively examined the effect of elective outpatient surgery on overall physical health, mental health, depression, or PTSD severity in a sample of veterans with preexisting PTSD.  This prospective, longitudinal, quasi-experimental, non-equivalent control group study will use a mixed-method paradigm to evaluate the impact of elective outpatient surgery on the functional health status of veterans with service-connected (PTSD).  Targeting the outpatient surgical population offers two unique benefits to the proposed research.  First, recruiting from the outpatient population addresses a greater proportion of the population at risk, as up to 65% of surgeries are performed on patients who do not remain in hospital overnight.  Second, the outpatient population provides a unique opportunity to disaggregate the adverse effects of anesthesia and surgery from the adverse effects of hospitalization.  We propose to recruit 40 veterans with service-connected PTSD who are scheduled for elective outpatient surgery.  Functional health, PTSD severity, depression severity, pain, and situational anxiety will be measured before surgery and at one month and three months postoperatively.  We will compare changes in these constructs over the three month time period with parallel data collected from a control group of 40 veterans with service-connected PTSD who do not undergo elective surgery.  The primary aim of the proposed research is to determine if exposure to elective, outpatient surgery under general anesthesia results in a decline in functional health status in veterans with PTSD.  The secondary aim of this research is to determine if outpatient elective surgery exacerbates PTSD or depression severity in veterans with PTSD. The ultimate goal of this research is to identify and design interventions that can positively influence physical and mental health after surgery in veterans with PTSD.       

Relevance: This study will add to our understanding of how patients with PTSD recover from surgery, and how surgery affects psychopathology in this population.  The data obtained from this research has the potential to immediately improve risk counseling for patients with PTSD who require surgery, and will be used to determine what constructs should be measured or manipulated in future research to reduce that risk.

Final Report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2013103...