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

  • Renée El-GabalawyEmail author
  • Jordana L. Sommer
  • Robert Pietrzak
  • Donald Edmondson
  • Jitender Sareen
  • Michael S. Avidan
  • Eric Jacobsohn
Review Article/Brief Review

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.

Stress post-traumatique en période postopératoire : état de la situation et orientations futures

Résumé

Objectif

Ce compte rendu narratif résume la littérature actuelle sur le stress traumatique postopératoire, soit l’état de stress post-traumatique (ESPT, PTSD en anglais), notamment ses caractéristiques déterminantes, son épidémiologie, l’identification des facteurs de risque périopératoires et de ceux liés au patient, les outils d’évaluation, les recommandations d’intervention et les orientations futures.

Constatations principales

Le stress traumatique postopératoire survient chez environ 20 % des patients après une chirurgie, et les taux sont plus élevés dans certains groupes chirurgicaux spécifiques. Les facteurs de risque potentiels comprennent la nature inhérente perçue comme incontrôlable des chirurgies à risque élevé, des antécédents psychiatriques, le réveil peropératoire, la dissociation, les complications chirurgicales, l’administration de médicaments, le delirium et la douleur. À la suite d’une chirurgie, un ESPT peut prendre des formes distinctes des présentations typiques de l’ESPT. L’identification des facteurs de risque périopératoires et des symptômes de stress en période postopératoire précoce pourraient permettre d’intervenir adéquatement.

Conclusion

La recherche sur le stress traumatique postopératoire, y compris l’ESPT, en est à ses balbutiements. Les données probantes actuelles témoignent de taux d’incidence élevés de stress traumatique postopératoire, lesquels peuvent détériorer les pronostics globaux de santé physique et mentale. Des recherches futures sur l’évaluation, la prévention et les traitements sont nécessaires.

Notes

Acknowledgement

This work was supported by University of Manitoba Start-Up Funding awarded to El-Gabalawy.

Conflicts of interest

None declared.

Editorial responsibility

This submission was handled by Dr. Gregory L. Bryson, Deputy Editor-in-Chief, Canadian Journal of Anesthesia.

Author contributions

Renée El-Gabalawy, Jordana L. Sommer, and Robert Pietrzak contributed to all aspects of this manuscript including literature search, study conception and design, interpretation of data, and drafting the article. Donald Edmondson, Jitender Sareen, Michael S. Avidan, Robert Pietrzak, and Eric Jacobsohn contributed to interpretation of data and drafting the article.

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Copyright information

© Canadian Anesthesiologists' Society 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology, Perioperative and Pain Medicine, Max Rady College of MedicineUniversity of ManitobaWinnipegCanada
  2. 2.Department of Clinical Health Psychology, Max Rady College of MedicineUniversity of ManitobaWinnipegCanada
  3. 3.Department of PsychiatryYale University School of MedicineNew HavenUSA
  4. 4.U.S. Department of Veterans Affairs National Center for Posttraumatic Stress DisorderWest HavenUSA
  5. 5.Center for Behavioral Cardiovascular Health, Department of MedicineColumbia University Medical CenterNew YorkUSA
  6. 6.Department of Psychiatry, Max Rady College of MedicineUniversity of ManitobaWinnipegCanada
  7. 7.Department of AnesthesiologyWashington University School of MedicineSt. LouisUSA

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