Post-traumatic stress in the postoperative period: current status and future directions

Abstract

Purpose: This narrative review summarizes the current literature on postoperative traumatic stress, namely post-traumatic stress disorder (PTSD), including defining features, epidemiology, identification of patient and perioperative risk factors, assessment tools, intervention recommendations, and future directions.

Principal findings: Postoperative traumatic stress occurs in approximately 20% of patients following surgery, with additionally elevated rates in specific surgical groups. Potential risk factors include the perceived uncontrollable nature of high-risk surgery, psychiatric history, intraoperative awareness, dissociation, surgical complications, medication administration, delirium, and pain. PTSD after surgery may manifest in ways that are distinct from traditional conceptualizations of PTSD. Identification of perioperative risk factors and stress symptoms in the early postoperative period may provide opportunities for intervention.

Conclusion: Research on postoperative traumatic stress, including PTSD, is in its infancy. Current evidence shows elevated incidence rates of postoperative traumatic stress, which can worsen overall physical and mental health outcomes. Future research on assessment, prevention, and treatment is warranted.